Senior Executive - PRU Medical Network Operations

Senior Executive - PRU Medical Network Operations

Prudential Financial, Inc
5-8 years
Not Specified

Job Description

At Prudential, we understand that success comes from the talent and commitment of our people. Together, we have a shared vision in securing the future of our customers and our communities. We strive to build a business that can shape, an inclusive workplace where ideas are valued and a culture where can thrive together. Our people stay connected and tuned in to what's happening around us, keeping us ahead of the curve. While focused on the long-term, we look to the future to bring growth, development and benefit to everyone whose lives we touch.
  • To monitor and to ensure that that following processes in his/ her team are in place, made 100% accurate and according to following service level timeline.
  • To ensure that all teams is manned efficiently by carefully monitoring planning shifts and schedules proposed by his/ her senior executives.
  • To ensure that daily interim bill is communicated to related parties through dashboard.
  • To ensure that the function adhere to policy condition, by performing quality assurance in all team activities and by giving regular training.
  • To ensure that no backlog in all PMN Operations processes by monitoring dashboard and data analytic of the workload.
  • To ensure that problem prompt escalation to supervisor is real time, by making him/herself 24/7 contactable and giving prompt response to an escalation
  • To maintain clear communication and warm relationship to all related parties.
  • To give decision on approving / disapproving preauthorization requests, discharge planning requests, case monitoring approval requests, and claim settlement requests.

  • Medical Doctor/ health /medical related field (5 years working experience)
  • 2 years relevant experience (Preauthorization process, Discharge planning, Case Monitoring and Cashless Claim Process).
  • Good understanding of preauthorization process, discharge planning, case monitoring and cashless claim process.
  • Understanding of underwriting, policy issuance and membership maintenance processes is a plus point.

Job Details

Prudentialplc provides life and health insurance and asset management, with a focus on Asia and Africa. We help people get the most out of life, by making healthcare affordable and accessible and by promoting financial inclusion. We protect people's wealth, help them grow their assets, and empower them to save for their goals. The business has more than 18 million life customers in Asia and Africa.Prudential has been providing trusted financial security for 95 years and is listed on stock exchanges in London, Hong Kong, Singapore, and New York. We are proud to be included in the 2022 Bloomberg Gender Equality Index. The index measures gender equality across five pillars: female leadership and talent pipeline, equal pay and gender pay parity, inclusive culture, sexual harassment policies, and pro-women brand. Our inclusion in this global index is testament to our commitment to nurturing diverse talent. #BloombergGEI . Prudential plc is not affiliated in any manner with Prudential Financial, Inc., a company whose principal place of business is in the United States of America or with the Prudential Assurance Company, a subsidiary of M&G plc, a company incorporated in the United Kingdom.

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