Health Services Specialist (1 Year Contract) - #1129216

Job Profile Summary:

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 Health Services Consultant, you will contribute directly to improving customer satisfaction and enhancing operational efficiency.
 

Job Description:

• 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.

  • Analyse 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).

  • Categorise email enquiries type and status via SAP.

• Support for Concierge Duties

  • Verify the customer data from internal working files (Patient Consent forms) submitted by concierge teams in the partner hospitals.

  • Verify and assess customers’ eligibility and qualification for transport voucher issuance in accordance with the applicable eligibility guidelines.

  • Cross-reference and match customer email addresses against internal databases to ensure accuracy.

  • Contact customers directly to verify and update their email addresses if discrepancies are found.

• Specialist Appointment booking

  • Receive and manage appointment booking requests submitted through the SAP Platform.

  • Contact customers within 2 hours of receiving the request to verify appointment details, including preferred panel specialists, clinic location, and other relevant information.

  • Advise customers on applicable panel benefits to support informed decision-making.

  • Coordinate with partner healthcare institutions or specialist clinics to secure an appointment within 3 working days, on a best-effort basis.

  • Follow up with customers via phone or email to confirm final appointment details and ensure a seamless booking experience.

  • Maintain accurate records of communications and booking status in internal systems.

  • Escalate any unresolved or urgent booking issues to the relevant internal teams as required.

• Website Management

  • Assist in updating website content in CMS, including text, images, etc.

  • Regularly check the Prudential website for broken links, errors, and outdated content, and report issues to the project lead.

  • Use CMS platforms to upload and organise content under supervision.

  • Provide input on website usability and navigation and assist in collecting feedback from users.

  • Liaise with internal teams and external vendors/partners to ensure accuracy of content deployed on website and ensure timely updates and consistency across the website.

  • Assist in testing website functionality across browsers, devices to ensure responsiveness and compatibility.

  • Edit and upload web-friendly graphics or images using tools like Canva or Photoshop (if applicable)

  • Help with new website development or redesign projects by preparing content, organising files, and participating in planning meetings.

Who we are looking for:

Skills & Competencies:

• Friendly, proactive and service oriented individual.

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

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

Education & Experience:

• Diploma or bachelor’s degree in healthcare administration, business, or a related field

• 3–5 years of experience in customer service or call center operations, preferably within integrated shield or life insurance

• Experience handling customer service enquiries, and agency relationships is preferred

• M5, M9, and HI qualification