M - Health Underwriting (UW) and Claims Governance Specialist

Prudential’s 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 people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Principle Duties & Responsibilities:

Underwriting Governance

• Regularly review underwriting guidelines and policies for existing health insurance products and campaign to ensure compliance with regulatory and internal policies, as well as market relevance (eg. Competitivenes, etc).
• Review technology support for Underwriting to ensure alignment with health business strategy.
• Monitor relationship/performance management with related 3rd party (eg. Re-ass, MCU panel, DMC, Dukcapil, etc) to ensure 3rd party performance evaluations are conducted and align with health business strategy.
• Setup UW governance reporting (eg. Governance Issue Log, Policy/Framework Changes, UW Risk and Incident registration, UW Cadence Checklist, etc).
• Conduct necessary communications/socializations on group policy changes and facilitate discussions with group in relation to the policy changes.

Claim Governance

• Regularly review Claim Framework and SOP (eg. Authority limit framework, Customer/Agents Feedback and Escalation framework, Ex-gratia, etc) to ensure compliance with regulatory, group policies and market conditions.
• Review technology support for Claims to ensure alignment with health business strategy.
• Monitor relationship/performance management with related 3rd party (eg. Re-ass, Hospital Network, DMC, Dukcapil, OCR, etc) to ensure 3rd party performance evaluations are conducted and align with health business strategy.
• Setup Claim governance reporting (eg. Governance Issue Log Changes, Risk and Incident registration, Cadence Checklist, etc).
• Conduct necessary communications/socializations on group policy changes and facilitate discussions with group in relation to the policy changes.

Job Requirements

• Bachelor's degree in Insurance, Business Administration, or a related field.
• Minimum of 5 years of experience in health insurance underwriting and claims management.
• Have the knowledge of Health Insurance Regulations, and Industry standards.
• Have the concept understanding of Underwriting and Claims, would be good if owned LOMA certifications or equivalent.
• Experienced in Underwriting and Claims practices (eg. Underwriters, Claim Analysts, UW/Claim manager, etc).
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Proficiency in insurance software and Microsoft Office Suite.
• Ability to work independently and as part of a team.

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organization 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.

Prudential’s 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 people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Principle Duties & Responsibilities:

Underwriting Governance

• Regularly review underwriting guidelines and policies for existing health insurance products and campaign to ensure compliance with regulatory and internal policies, as well as market relevance (eg. Competitivenes, etc).
• Review technology support for Underwriting to ensure alignment with health business strategy.
• Monitor relationship/performance management with related 3rd party (eg. Re-ass, MCU panel, DMC, Dukcapil, etc) to ensure 3rd party performance evaluations are conducted and align with health business strategy.
• Setup UW governance reporting (eg. Governance Issue Log, Policy/Framework Changes, UW Risk and Incident registration, UW Cadence Checklist, etc).
• Conduct necessary communications/socializations on group policy changes and facilitate discussions with group in relation to the policy changes.

Claim Governance

• Regularly review Claim Framework and SOP (eg. Authority limit framework, Customer/Agents Feedback and Escalation framework, Ex-gratia, etc) to ensure compliance with regulatory, group policies and market conditions.
• Review technology support for Claims to ensure alignment with health business strategy.
• Monitor relationship/performance management with related 3rd party (eg. Re-ass, Hospital Network, DMC, Dukcapil, OCR, etc) to ensure 3rd party performance evaluations are conducted and align with health business strategy.
• Setup Claim governance reporting (eg. Governance Issue Log Changes, Risk and Incident registration, Cadence Checklist, etc).
• Conduct necessary communications/socializations on group policy changes and facilitate discussions with group in relation to the policy changes.

Job Requirements

• Bachelor's degree in Insurance, Business Administration, or a related field.
• Minimum of 5 years of experience in health insurance underwriting and claims management.
• Have the knowledge of Health Insurance Regulations, and Industry standards.
• Have the concept understanding of Underwriting and Claims, would be good if owned LOMA certifications or equivalent.
• Experienced in Underwriting and Claims practices (eg. Underwriters, Claim Analysts, UW/Claim manager, etc).
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.
• Proficiency in insurance software and Microsoft Office Suite.
• Ability to work independently and as part of a team.

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organization 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.