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Job Profile Summary

In this role, the incumbent is responsible for leading a dedicated servicing team that provides premium claims support to qualified Health & Protection (H&P) Club members. The role acts as the key bridge between the H&P Club qualifiers and our claims team to deliver exceptional service experiences throughout the claims journey, which includes claims adjudication of all claim types (Health and Protection) within the stipulated SLA.

The incumbent will ensure timely resolution of claims-related enquiries, champion service excellence, drive customer advocacy, and provide leadership to a team of Claims Servicing Specialists. The role is focused on servicing and relationship management aside to claim adjudication, enabling qualified advisers and their customers to receive proactive support and timely updates on claims matters within stipulated turnaround.

Job Description

1. People Management

• Lead, coach and develop a team of Claims Servicing Specialists.
• You will lead a team of four claims specialists
• Drive a customer-centric culture focused on responsiveness, professionalism and empathy.
• Set service standards, team objectives and performance expectations.
• Conduct regular coaching, capability development and quality reviews.
• Foster a collaborative and high-performing work environment aligned with Prudential Values and PRUWay behaviours.

2. Premium Claims Servicing

• Oversee end-to-end servicing support for H&P Club members and their customers.
• Ensure prompt resolution of claims enquiries and service requests (within 24 hours in claims resolution).
• Act as the escalation point for complex and sensitive service issues.
• Coordinate with Claims Assessors to facilitate claim progression and timely communication.
• Provide proactive updates to H&P advisers on critical, urgent and high-impact claims cases.
• Drive service recovery efforts where service expectations are not met.

3. Stakeholder Management

• Build strong partnerships with:
  • H&P qualifiers
  • Claims BAU team
  • Healthcare Institutions
  • Technology Teams
• Serve as the primary point of contact for escalated H&P Club servicing matters.
• Support agency engagement sessions and feedback forums to continuously improve service delivery.

4. Operational Excellence

• Monitor and manage:
  • Service turnaround times (within 24 hours of the enquiry)
  • Productivity metrics
  • Quality standards
  • Distribution feedback
• Identify service gaps and implement process improvements.
• Support operational readiness for system enhancements and service initiatives.
• Drive efficiency through automation and digital servicing opportunities.

5. Governance, Risk and Compliance

• Ensure all servicing activities comply with:
  • Internal policies and claims SOPs
  • Regulatory requirements
  • Data privacy obligations
  • Audit requirements
• Ensure accurate documentation of customer interactions and servicing actions.
• Support audit reviews and remediation activities where required.
• Escalate operational risks and customer issues in a timely manner.

6. Transformation and Continuous Improvement

• Participate in strategic initiatives related to claims servicing transformation.
• Support implementation of AI-driven servicing capabilities and digital customer journeys.
• Collaborate with business and technology teams in:
  • Requirement gathering
  • User Acceptance Testing (UAT)
  • Process redesign
  • Service enhancement initiatives
• Use customer and adviser feedback to drive continuous improvements.
• Support the team on Quality Checks for STP claims, both inpatient and PP claims and report back (feedback loop) to the Team Leads and Technical team

Who Are We Looking For:

Qualifications & Experience

• Diploma or Degree in Healthcare, Insurance, Business, or Administration or related discipline is preferred
• Minimum 5-8 years of experience in Health and Life Claims, Customer Service, Insurance Operations, or Healthcare Administration.
• At least 2-3 years in a leadership or supervisory capacity.
• Strong understanding of:
  • Life plans
  • Integrated Shield Plans
  • Health insurance claims processes
  • Customer servicing operations
  • Regulatory and governance requirements

Skills & Competencies

• Strong passion for customer advocacy and service excellence
• Data-driven and results-oriented with a continuous improvement mindset.
• Ability to inspire, motivate and develop high-performing teams.
• Builds trusted partnerships across multiple business functions.
• Able to navigate complex servicing situations and develop practical solutions.
• Able to multi-task in a fast-paced environment
• Able work under pressure and fulfil last minute tasks assigned within tight timeline and manage high claim volumes
• Proficient in Microsoft Office (Excel, Word) and claims systems (preferred)
• Excellent verbal and written communication skills.
• Responsible and reliable with strong work discipline
• Customer-focused mindset

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.