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.

The HOD has the key responsibility in providing leadership to end-to-end claims process for both individual policies and employee group benefit claims, including pay and file, cashless guarantee letter admissions, team production and claims investigations, projects and streamlining/automation of processes. This role requires a strategic leader with a deep understanding of insurance claims management, exceptional operational skills, and the ability to drive efficiency and customer satisfaction in claims processing.

Job Description:

1. Claims Operations

Oversee the processing of medical and life insurance claims for individual policies and employee group benefits.
Ensure productivity timely and accurate processing of pay and file claims and cashless guarantee letter admissions
Develop and implement claims management strategies to improve efficiency and customer satisfaction.
Develop and maintain staff rosters ensuring optimal coverage and compliance with labor laws.
Fraud Investigations are carried out timely and accordingly.

2. Team Leadership

Lead and manage the claims operations team, including claims processors, investigators, and support staff.
Provide training, mentorship, and performance evaluations to team members.
Foster a collaborative and high-performance work environment.

3. Operational Excellence:

Streamline claims processing workflows to enhance productivity and reduce turnaround times.
Implement best practices and continuous improvement initiatives in claims operations.
Monitor key performance indicators (KPIs) and ensure compliance with regulatory requirements.

4. Customer Services:

Ensure a customer-centric approach in all claims handling processes.
Address and resolve escalated claims issues and customer complaints.
Collaborate with customer service teams to enhance the overall customer experience.

5. Stakeholder Management:

Collaborate with internal and external stakeholders, including underwriters, brokers, and healthcare providers.
Maintain strong relationships with key partners to facilitate smooth claims processing.
Represent the claims department in meetings and industry forums.

6. Reporting and Analysis:

Prepare and present regular reports on claims performance, trends, and areas for improvement.
Utilize data analytics to drive decision-making and strategic planning.
Ensure accurate and timely reporting to senior management.
Manage the claims budget and ensure cost-effective operations

7. Project Management to ensure smooth system migration for product roll out , timely UAT, operations enhancement

Qualification and Experience:

Bachelor's degree in Business Administration, Insurance/Takaful, or a related field is required.
A minimum of 8-10 years of experience in operation management, preferably in medical insurance operations, with at least 5-10 years in a leadership role.
In-depth knowledge of medical and life insurance claims operations, including pay and file and cashless guarantee letter admissions.
Strong leadership and team management skills are essential.
Excellent analytical and problem-solving abilities are required.
Exceptional communication and interpersonal skills are necessary.
Proficiency in claims management software and data analytics tools is a must.
Experience in strategic planning and execution is required.
A commitment to customer service excellence is essential.
Financial acumen is necessary for this role.
Knowledge of compliance and regulatory requirements is crucial.
Strong analytical and problem-solving abilities are required.
Project management experience is highly desirable.

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.