Senior Manager, Claims

Prudentials 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 peoples career ambitions. We pledge to make Prudential a place where you can Connect Grow and Succeed.

Roles & Responsibilities:

Medical Reimbursement & Accidental Claims

• Oversee inpatient/outpatient medical reimbursement personal accident and allowance benefit claims.

• Ensure fairly and timely assessments based on certificate terms.

• Monitor workloads and optimize claim clearance processes.

• Review complex claims or those requiring additional clarification.

• Lead agency servicing platform development and claim system enhancement.

Major Claims (Death TPD Critical Illness

• Manage high value claims requiring medical shariah and legal review.

• Ensure consistent decision making aligned with certificate terms and underwriting intent.

• Handle escalated disputed or fraudulent claims appropriately.

• Coordinate with Legal Shariah Risk and Retakaful Operator for complex or high-risk cases.

• Lead agency servicing platform development and claim system enhancement.

• Manage the MTJ and SIKR claims portfolio including involving in JFC updates.

Group & Affinity Claims including TPA Management

• Oversee group and corporate client claims ensuring SLA fulfillment.

• Monitor TPA performance including regular audits and feedback sessions.

• Work with Corporate Group Business team on claims management.

• Ensure transparent reporting and client engagement.

• Lead agency servicing platform development and claim system enhancement.

Cashless and Non-Cashless Claim Payments

• Supervise post discharge claim settlements.

• Ensure cashless claims payment processes are handled efficiently through digital tools.

• Manage provider network queries and payment disputes.

• Oversee prompt and accurate reimbursement for non-cashless claims including those in group claims portfolio.

• Manage claim suspense account and trigger unclaimed money process.

• Manage medical report fees reimbursement and payment replacement for rejected payments.

• Lead agency servicing platform development and claim system enhancement.

Strategic leadership and team management

• Develop and mentor team leads and successors.

• Foster a high performance collaborative and customer-focused culture.

• Align team structure and resources with business demand.

Job Requirements:

• Bachelors degree in insurance Business Administration Medical Science Actuarial Science or a related field.

• Professional insurance certifications such as Fellow Life Management Institute (FLMI) Associate Insurance Institute (AII) or equivalent industry qualifications. Training in leadership operational excellence or process improvement methodologies (e.g Lean Six Sigma project management) will be an added advantage.

• Minimum 10 years of experience in insurance/takaful claims management preferably covering life health and group business portfolios with 3 years in a senior leadership or managerial role overseeing multiple functional teams.

• Proven track record in managing diverse claims portfolios (medical reimbursement accidental death TPD critical illness cashless/non-cashless payments group/affinity claims; handling sensitive high value and complex claims with sound judgement; managing TPA performance audit and SLAs; d) driving process improvement digital transformation and operational efficiency in claims

• Experience working with cross-functional teams (e.g Underwriting Risk Compliance Legal Shariah Customer Service IT) and external stakeholders such as Retakaful operators corporate clients and medical providers.

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.