Executive, Claims - Kuala Lumpur, Malaysia - Prudential plc

Description

Prudential's purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

1. Ensure all Pre-Authorization Letter (PAL) request faxed or emailed by hospitals to be indexed and registered into claims system accordingly.

2. Validate the information stated in the Pre-Authorization Form completed by the client and attending doctor, assess the request, calculate the correct amount coverable and make a correct decision accordance to benefit terms & Claims SOP.

3. Ascertain the accurate data entry such as ICD10 Diagnosis Code, Surgery and Consultation Code (per PHA Schedule) and items charged per bills issued by hospital.

4. Liaise with hospital personnel including nurses and doctors via phone-call / emails/ writing letters appropriately to obtain necessary information in processing PAL request.

5. Process Pre-Authorization Letter request within the agreed Service Level accordance to daily productivity target.

6. Participate in product and technical trainings as well as work with supervisor for additional training plans in acquiring and improving industry or technical knowledge.

7. Ensures compliance with all regulatory (internal and external) and corporate requirements.

8. Manage customer /agents/ hospitals complaints or enquiries and provide feedback/response appropriately.

9. Any other tasks given by HR, company or department activities/directives as well as Ad-hoc function as requested by Section Head or HOD