Medical Advisory, Case & Fraud Management, Specialist

AIA Group

Not specified
5 years medical claim experience
Medical coding proficiency
Fraud waste and abuse identification
AIA Group is seeking a Medical Advisory, Case & Fraud Management Specialist to identify and manage fraud, waste, and abuse in medical claims. The ideal candidate should have extensive experience in medical claims assessment and possess a strong understanding of health insurance policies

Job Summary

  • The role involves identifying patterns of fraud, waste, and abuse while implementing risk management measures.
  • Candidates must conduct surgical and medical history checks on claims to ensure accurate pricing and exclusions.
  • The position requires providing medical advisory for disputed charges and maintaining fraud tools with insightful analysis.

Matching Summary

Match Score: 85

AIA Group is seeking a Medical Advisory, Case & Fraud Management Specialist to identify and manage fraud, waste, and abuse in medical claims. The ideal candidate should have extensive experience in medical claims assessment and possess a strong understanding of health insurance policies.

Skills & Requirements

Must-have

  • 5 years medical claim experience
  • Medical coding proficiency
  • Fraud waste and abuse identification
  • 13th Schedule knowledge
  • MOH letters expertise
  • Reasonable and customary charges

Nice-to-have

  • Process improvement skills
  • System automation collaboration
  • Mentoring team leaders
  • Robust medical training delivery
  • Effective cost containment strategies

Key Requirements

  • Bachelor's Degree or Diploma
  • Minimum 5 years medical claim experience
  • Proficiency in English and Bahasa Malaysia

Work Rights

Not specified

Tailored Resume

Cover Letter