Health Services Specialist - Claims Recovery

PRUShield Claims recovery is a core initiative under the Health Portfolio Management team, designed to help customers submit claims to third-party insurers.

As a Health Services Specialist within the Health Portfolio Management team, you will be responsible for supporting customers and financial consultants through the PRUShield Claims Recovery process. This involves guiding customers in submitting claims to third-party insurers by initiating 2-way SMS outreach, conducting follow-up calls, and assisting in the collation and submission of medical documentation to HR departments and group insurers. You will also promote awareness of recovery claim benefits and ensure a smooth end-to-end experience for all stakeholders. The role demands strong communication skills, attention to detail, and a commitment to achieving daily performance targets such as call productivity, contact rate, and claim success rate. Reporting to the Lead, Health Services, you will contribute directly to improving customer satisfaction and enhancing operational efficiency.

• Third Party Recovery

• Conduct daily outbound calls to customers to raise awareness and promote the benefits of submitting a recovery claim.

• Adhere strictly to customer data protection protocols, including Personal Data Protection Act (PDPA) requirements, during all inbound and outbound interactions.

• Guide and assist customers throughout the recovery claims process, addressing queries and offering support with documentation and submission. · Provide end-to-end case management for each assigned customer, ensuring smooth progression from initial contact to final resolution.

• Ensure all assigned call leads are acted upon promptly and effectively, with no lead left unutilized or wasted.

• Perform administrative tasks such as arranging courier, handling of medical reports, scanning and printing documents to support claim submissions. Conduct follow-ups after claim submissions to confirm successful processing and address any outstanding issues.

• Participate in ongoing service briefings, product trainings, and technical workshops as required to stay updated on product/regulatory changes.

• Third Party Recovery Mailbox

• Respond to customer enquiry in a timely and accurate way via email.

• Identify customer needs and assist customers use specific features of our online portal and website.

• Analyze and report any red flag to team lead.

• Produce a structured and professional replies, considering, the tone, timing and presentation of your replies so that they are effective and respectful.

• Address customer enquiries clearly and appropriately.

• Resolve email enquiries within the Service Level Agreement (SLA).

Categorize email enquiries type and status via SAP.

• Third Party Recovery Hotline

• Answering incoming calls from internal and external customers and Financial Consultants, addressing inquiries, resolving issues, and documenting interactions in Life Asia system.

• Possess strong communication, active listening, and problem-solving skills, as well as the ability to work with various software, systems and online portals.

• Aspire to provide a one-call resolution experience to internal and external customers and Financial Consultations.

• Takes ownership of the enquiry and if required, provide follow up to ensure proper closure to the enquiry.

• Collaborating with team members and other departments to achieve our customer centricity goal and improve customer experience.

Who we are looking for:

Skills & Competencies:

• Friendly, proactive and service oriented individual.

• Team player and enjoys being in a target driven team.

• Two years’ experience with outbound or in-bound call center environment.

• One to two years’ experience in integrated shield or life insurance preferred.

• Life insurance qualifications – Certificate in Life & Health Insurance.

Education & Experience:

• Diploma or Degree in healthcare administration, business, or a related field

• 3 – 5 years of experience in customer service

• Experience handling provider enquiries, contracts, and agency relationships is preferred

• M5, M9, and HI qualifications would be advantageous