Prudential plc
Claims QA Specialist (1 year contract)
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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.
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
- Review the rules of Straight through (STP) process of PP claim from web, data capture tools, MedLM etc.
- Involve in UAT testing i.e. involved in the Quality check of the cases adjudicated by the MedLM vis-à-vis the cases finalised by claim assessors
- Liaise with the project team of MedLM to ensure smooth delivery of the MedLM system
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
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.
