Job description
Prudential's purpose is to help people get the most out of life. We will deliver our purpose by creating a culture in which diversity is celebrated and inclusion assured, for our colleagues, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and in exchange, we support our people's career ambitions. We pledge to make Prudential a place where you can Connect, Grow and Succeed.
Assess claims in accordance with the certificate terms and conditions
Process claims; i.e. approve or reject within a set time frame.
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. Manage customer /agents/ hospitals complaints or enquiries and provide feedback/response appropriately.
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 special requirements.
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