AVP - Head of Claim (Sharia)

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.

This Head of Claim role is essential to ensure efficient, Shariah-compliant claims processing, fraud control, and customer satisfaction. The role drives strategic improvements, manages provider networks, ensures regulatory compliance, and leads cross-functional collaboration—critical for operational excellence, cost containment, and delivering high-quality health services.

Key Responsibilities:

• Develop and execute strategic plans for Claims and Medical Network operations in alignment with overall company objectives.
• Oversee end-to-end claims operations (life, medical, critical illness) ensuring efficiency, accuracy, and Shariah compliance.
• Monitor and analyze claims trends to detect fraud, reduce leakage, and identify process improvement opportunities.
• Drive initiatives to improve claims turnaround time and enhance automation and digitalization of claim processes.
• Ensure high levels of customer satisfaction through empathetic and timely claim handling.
• Expand and maintain a high-quality, cost-effective medical provider network across key geographies.
• Lead contract negotiations and performance management of medical providers and third-party administrators (TPAs).
• Develop and implement provider quality assurance frameworks, pricing controls, and service level agreements.
• Build strong relationships with hospitals, clinics, and healthcare partners to support service excellence.
• Ensure full compliance with regulatory requirements and Shariah governance in claims and medical network operations.
• Lead internal controls and fraud detection mechanisms to manage operational and reputational risk.
• Collaborate with cross-functional teams including Product, Actuarial, Risk, Legal, and Customer Service to ensure seamless health service delivery.
• Represent the Claims and Medical Network function in audits, reviews, and regulatory engagements.
• Lead, coach, and develop a high-performing team with strong technical and customer service capabilities.
• Set and monitor performance metrics, budgets, and cost-containment goals for both claims and network functions.

Job Requirements:

• Bachelor’s degree in Medicine is strongly preferred.
• AAAIJ certification is strongly preferred; FLMI is a plus.
• Minimum 10 years in life insurance claims, with at least 6 years in a senior leadership role (e.g., AVP, Senior Manager). Additional qualifications in insurance, business, or law are beneficial.
• Proven experience managing end-to-end life insurance claims, including death, health, disability, and pension.
• In-depth understanding of OJK regulations, Indonesian insurance laws, and TPA operations.
• Skilled in developing claims strategies, leading claims transformation initiatives, and driving operational efficiency.
• Ability to analyze claims trends, detect fraudulent patterns, and ensure fair and accurate claim outcomes.
• Experience with digital claims platforms, process automation, and technology-driven claims solutions.

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.