Senior Manager, Customer Promise - Healthcare Claims

The incumbent is responsible to manage an efficient and effective Claims team by meeting and exceeding management’s expectations on operational processes. The complexity of the insurance business requires the incumbent to acquire a thorough knowledge of the different insurance products (and their functionalities / technicalities) and operational processes to ensure customer’s enquiries are resolved in accordance with agreed service levels. The incumbent is also required to work closely with other operations departments in delivering excellent service quality to customers.

Position Summary:
 Lead and manage the overall Claims Section Operations, to drive operational excellence across all claims handling activity
 Planning of staff roster for 24/7 Operation team
 Planning overall strategy of the Unit
 Managing the day to day functions of the Unit which include people, system, procedures and others.

PRINCIPAL DUTIES & RESPONSIBILITIES:
 Appraising claims up to a company-specified approval limit.
 Strategic planning, managing, coordinating, controlling and monitoring the Unit plans to ensure that the operational objectives of the department and the company are being met.
 Responsible in ensuring appropriate measures and controls on claims leakages and fraud management, monitoring of legal cases are adhered to.
 Assessing critical legal and industry issues on claims with high ambiguity and exposures to the company.
 Ensuring that Insurance Act, Bank Negara Malaysia, Anti-Money Laundering & Counter-Financing of Terrorism (AML/CFT) efforts, LIAM guidelines and internal guidelines are strictly complied with as applicable.
 Applying complicated theory and fundamentals of claims appraisals.
 Ensuring company-specific claims policy and guidelines are in line with Prudential Malaysia Claims policy and standards. This includes defining and implementing standards for accuracy, productivity and timeliness as well as recommending strategies to meet those standards.
 Reviewing and revising claims guidelines regularly to ensure that they are aligned with changes in the market, legal and regulatory environments, and product design.
 Supervising the performance of subordinates.
 Representing the department head in meetings.
 Implementing projects for the streamlining of operations or improvement of servicing capabilities.
 Determining appropriate training for subordinates to ensure that they are keeping up with market and business requirements.
 Maintain effective relationships with key stakeholders and collaborate with across business units to provide claims input into business decisions, budgeting process etc.

JOB SPECIFICATION
University Degree with a focus in Business, Accounting, Risk Management (Insurance) or other related discipline

Minimum 8 years of experience in claims including 5 years at managerial level, 5 years in insurance claims administration and assessment (all claim types) and expert knowledge of the insurance industry and insurance claims. Expert level in managing a large team of people. Preference for those with experience in underwriting, medical or legal aspects of claims.