Job Profile Summary:
In this role, you will review, assess and approve shield claims within service turnaround time. As part of this dynamic role, you will report to Team Lead, PruShield Claims and work closely with various stakeholders to ensure that the output is accurate and compliant to internal policy and regulatory requirements.
Job Description:
• Review, assess and approve shield claims within service turnaround time. Ensure the output is accurate and compliant to internal policy and regulatory requirements.
• Attend to claims investigations, service recovery and enquiry
• Attend to medical clarification with hospitals and clinics
• Involve in projects assigned by supervisor
• Provides quality customer service including interacting with customers, answering customer enquiries and effectively handling customer complaints
Job Scope
- Claims adjudication process.
- Manage enquiries, service recovery, complaints and appeals.
- Provide customer support with external & internal parties – Central Provident Fund. Board (CPFB), Financial Consultants, Bancassurance partners, Medical Institutions, Call Centre & Customer Management Teams.
- Attend to eLog requests from Customers & Hospitals staff.
- Support Agency Leaders with claim enquires via Claims counter servicing.
Provide Net Promoter Score Analysis upon Customers feedback.
Who we are looking for:
Competencies & Personal Traits
• Strong command of the English language (spoken and written)
• Familiarity with human anatomy, general diseases and disease management
Working Experience
• 4 years of experience as a Life & Health claims assessor
Professional Qualifications
• OMA, FLMI (Fellow, Life Management Institute)
Education
• Degree holder of biology & life sciences discipline
Language
• English
