Claims Servicing Specialist (H&P Club)

In this role, the incumbent will support the Team Lead in delivering premium claims servicing support to Health & Protection (H&P) Club members and their customers. The role serves as a dedicated point of contact for claims-related enquiries, review and adjudicate claims related to Health and Protection plans, case navigation, and service coordination, ensuring a seamless and differentiated customer experience.

The incumbent will work closely with the 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.

The incumbent will ensure timely resolution of claims-related enquiries, champion service excellence and drive customer advocacy. 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. Premium Claims Servicing

• Serve as the primary servicing contact for assigned H&P Club members and their customers.
• Respond promptly to claims-related enquiries from advisers and customers.
• Provide clear guidance on claims requirements, documentation, and processes.
• Facilitate end-to-end tracking of claims cases and ensure timely updates are communicated.
• Coordinate urgent and customer-sensitive cases to ensure appropriate prioritization.
• Support customers throughout their claims journey with empathy and professionalism.

2. Case Management and Coordination

• Monitor and manage a portfolio of claims servicing cases from both Health and Life claims.
• Liaise with Claims Assessors to obtain status updates and facilitate timely resolution of enquiries.
• Process claims that are enquired by the H&P qualifiers within claims authority limits
• Proactively identify and escalate cases requiring immediate attention.
• Coordinate with Agency Teams, Customer Service Teams, Healthcare Institutions, Medical Providers and Internal Operations Teams

3. Agency Support

• Build trusted relationships with H&P Club qualifiers and Agency Leaders.
• Provide timely responses to claims-related enquiries and escalation matters.
• Assist advisers in understanding claims requirements and customer communication needs.
• Participate in agency engagement activities, education sessions, and service briefings where required.
• Gather feedback from advisers and identify opportunities for service enhancement

4. Customer Experience Excellence

• Deliver a differentiated service experience for H&P Club members and customers.
• Demonstrate empathy and professionalism when handling vulnerable, complex, or sensitive situations.
• Support service recovery efforts for delayed or escalated cases.
• Maintain high standards of responsiveness and customer satisfaction.
• Identify recurring customer pain points and recommend process improvements

5. Operational Excellence

• Meet established service turnaround time (TAT) within 24 hours and productivity targets.
• Maintain accurate records of customer interactions and servicing activities.
• Track case ageing and proactively follow up on outstanding matters.
• Support reporting requirements relating to service performance and operational metrics.
• Contribute to continuous improvement initiatives to enhance efficiency and customer outcomes

6. Governance, Risk and Compliance

• Ensure adherence to Prudential policies, operational procedures, and regulatory requirements.
• Handle customer information with the highest standards of confidentiality and data protection.
• Escalate operational, compliance, and customer risks promptly.
• Maintain complete and accurate records for audit and governance purposes.

7. Support Transformation Initiatives

• Participate in claims servicing transformation projects and customer journey enhancements.
• Provide operational insights and frontline feedback for service improvements.
• Assist in the implementation of digital, automation, and AI-enabled servicing capabilities

Who Are We Looking For:

Qualifications & Experience

• Diploma or Degree in Healthcare, Insurance, Business, or Administration or related discipline is preferred
• Minimum 3 to 5 years of experience in both Health and Life Claims, Customer Service, Insurance Operations, or Healthcare Administration.
• 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.
• 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