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Jobs or company...

Medical Advisory, Case & Fraud Management, Specialist

Salary undisclosed
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At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About the Role

Responsible for providing technical medical expertise for underwriting decisions and resolution of customer enquiries and claims and managing healthcare related services provided to policy holders

Roles and Responsibilities

  • Provide professional guidance, medical advice and relevant training to product development, underwriting and claims colleagues.
  • Develop and implement AIA's healthcare programmes.
  • Work with medical and wellness suppliers to support AIA healthcare programmes.
  • May manage rehabilitation cases by assessing claimant's needs, developing rehabilitation plans, and arranging relevant services.
  • Pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company’s requirements and guidelines.
  • Lead the team and manage rostering / OT and FTE count needed for AGL and ADR.
  • Ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned.
  • Performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements.
  • Monitor of length of stay, reasonable and customary charges, to ensure there is no abuse in terms of admission and procedures During the adjudication of AGLs and ADR.
  • Mentor/coach and guide the TLs and assessors in robust decision making.
  • Ensure all guides and Cost savings initiatives are followed closely by Team leader and assessors.
  • Participate in outlining Medical training /roll downs according to the needs of the staffs.
  • Participate in analysis and audits that are pertinent to cost savings across various units in AIA.
  • Participate in process improvement initiatives pertaining to system enhancement and refining process flow for the team.
  • Collaborate with various units in AIA in ensuring cost savings and CAR is achieved.
  • Participate in workshops/seminars and discussion in cost saving initiatives/Fraud, waste and abuse matters.
  • Lead the Fraud, Waste and Abuse initiatives in conducting analysis.

Minimum Job Requirements

  • Candidate must possess at least a bachelor's degree, Post Graduate Diploma, Professional Degree or Master's Degree in Dentistry, Medicine, Medical Science, Biomedical, Nursing, Pharmacy, Pharmacology, Physiotherapy or equivalent.
  • Candidate with claim experience is an added advantage.
  • Fresh Graduate with medical background is encouraged to apply.
  • Technical Skills: Claims assessment, Medical report knowledge, Health Insurance Policy knowledge.
  • Industry: Health Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs.
  • Language: English and Bahasa Malaysia.
  • Willing to adhere with 24/7 shift working arrangement.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

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