Manager, Customer Promise - Healthcare Claims

Manager, Customer Promise - Healthcare Claims 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.

Manager, Customer Promise - Healthcare Claims

PRINCIPAL DUTIES & RESPONSIBILITIES:

• To handle incoming feedback, appeal and claim enquiries from internal or external parties via emails, phone calls, escalation from higher management
• Responsible for CRM, Ask me RAISe enquiries and email: [email protected] from various touchpoint ensuring proper closure of enquiry, feedback and claim appeal within agreed TAT

• Improving the overall agent and customer relationship, awareness creation to customers on contractual coverage, benefits, claims adjudication, excess non-eligible charges and reason for repudiation limited to medical claims
• Resolving agents' and other queries within agreed authority, investigating the cause of any complaints, gathering information from claims department and reviewing claims supporting documents
• Making fair, impartial decisions on whether to uphold a complaint in line with company and regulatory frameworks treating all customer fairly
• Gather customer and agency feedbacks to improve claims service standards and customer experience where appropriate
• Ensuring compliance with legal requirements, industry regulations, organizational policies and professional code of conducts

• Updating and submission of reports as required by management within the agreed service standards
• Continuously review and update/document the administrative rules and processes for effective and efficient operation of the sections (e.g. SOP)
• Acknowledging complaints promptly, close follow-up follow-though and responding to all parties within set time limits, systematically and fairly
• Continuously attend/ involve with training for personal and career development
• Provide continuous training to subordinates on claim assessment process on all minor reimbursement claims
• Summarizing any additional actions required, advising agents or customers when they can expect a final response, drafting and sending out correspondence
• Undertake projects / other work and duties allocated by management as and when required
• Monthly basis, to analyze the daily CT/ MT tickets, Ask Me RAISe enquiries and claims appeal to ensure minor/HAS operation delivers quality claim assessment and
• To analyze cases with error in claim assessment/ decision (financial/ non-financial), escalate to respective section Error Report PIC to log and provides feedback/ solution for continuous improvement
• To identify process/ system gap and escalate back to respective section owner with propose solution for system fix or process changes to close the identified gap

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements Job ID 24110384