Medical Advisory, Case & Fraud Management, Specialist at AIA Malaysia (Insurance) - Kuala Lumpur

The Medical Advisory, Case & Fraud Management Specialist is responsible for identifying patterns of fraud, waste, and abuse in medical claims. This role plays a crucial part in ensuring cost containment while maintaining the quality of care within the healthcare system.

In this position, you will engage in daily activities that involve analyzing medical claims and collaborating with healthcare providers to mitigate risks. You will work in a dynamic environment that emphasizes teamwork and continuous improvement.

Key Responsibilities:

• Identify patterns of fraud, waste, and abuse in medical claims.
• Conduct surgical history checks to validate claims.
• Implement risk management measures to prevent fraudulent activities.
• Perform reviews of hospitalizations to ensure cost containment.
• Provide medical advisory on disputed charges and appeals.
• Maintain and enhance fraud analysis tools.
• Conduct training sessions for staff and healthcare providers.
• Mentor team members and support their professional development.