8 Care Coordinator jobs in Malaysia

Position: Patient Care Coordinator (Kuala Lumpur)

Position Purpose: The Patient Care Coordinator will assist the Patient Care Leader in managing drug access program(s) in the region. The jobholder is required to help represent Axios in daily meetings with patients, doctors and carry out administration tasks.

A healthcare access company with 20+ years of experience developing sustainable solutions to patient access challenges in emerging markets through Patient Assistance Programs and Patients Support Programs.

SGS is the world’s leading inspection, verification, testing and certification company. SGS is recognized as the global benchmark for quality and integrity. With more than 99,600 employees, SGS operates a network of over 2,600 offices and laboratories around the world.

• Data entry for samples registration. Prepares and distributes samples.
• Monitor flow for incoming samples for registration.
• Ensure all activities comply with ISO 17025, SAMM policy, laboratory’s QA/QC system, and SGS GCSC requirements.
• Sample registration and monitoring of sample registration flow from receiving to distribution.
• Assist in coordinating daily operations, including record keeping and maintaining administrative records.
• Follow up on samples during absences.
• Maintain necessary records as required by supervisors and ensure good administrative practices.
• Adhere to SGS Health, Safety, and Environment (HSE) policies by practicing good safety behavior and following standards and processes to ensure compliance.
• Perform any other responsibilities assigned by your reporting manager or senior management.

• Minimum SPM qualification from any field.
• Diploma or Degree from a recognized university or college is an advantage.
• Able to work independently with minimal supervision.

Overview

The National University Cancer Institute, Singapore (NCIS) is a national specialist centre under the National University Health System (NUHS). It is the only public cancer centre in Singapore treating both paediatric and adult cancers in one facility. NUHS has been recognized as the #1 Public Healthcare employer for four consecutive years.

Join us as a Palliative Care Coordinator, where you'll guide patients and families through complex healthcare journeys. Your role will involve navigating, educating, data management, and providing compassionate care. You will gain satisfaction from direct patient care and contribute to efficient care coordination across diagnosis, treatment, rehabilitation, follow-up, survivorship, and end-of-life care.

1. Care Navigation

• Provide personalized informational and emotional support to patients and families to overcome healthcare system barriers, ensuring continuity and quality of palliative care.
• Identify high-risk patients and assist them through their healthcare journey, ensuring access to necessary resources.
• Follow up with patients via phone to facilitate access to the medical team, reducing unnecessary emergency visits and hospital admissions.
• Follow up with patients who defaulted on initial visits to ensure continuity of care.
• Assist patients and families in transitioning across different services and locations.
• Communicate effectively with healthcare professionals to ensure smooth transitions.
• Assess patients' physical, psychosocial, and spiritual needs, address barriers, and initiate appropriate interventions.
• Evaluate patient navigation outcomes.
2. Care Coordination
• Ensure compliance with palliative care pathways and streamline care for inpatients and outpatients.
• Facilitate smooth care transitions and appropriate patient placement, collaborating with community partners such as Palliative Home Care and inpatient hospice services.
• Coordinate referrals to specialists, allied health, and support services.
• Collaborate with internal stakeholders, including oncologists, radiologists, and other specialists, involved in patient care.
• Evaluate outcomes of care pathways.
B. Education
• Educate patients and families about palliative care, symptom management, and available resources.
• Triaging patients to subspecialty care.
• Advise clinic staff on referrals, community care options, and financial counseling estimates.
• Support multidisciplinary team members regarding patient care matters.
C. Data Management
• Compile data, build databases, and conduct annual audits.
• Assist with data analytics and participate in quality improvement projects.
• Collaborate with VDO teams to measure outcomes.
D. Research
• Coordinate palliative care research and quality improvement projects.
• Liaise with research staff and ensure compliance with ethics and data governance policies.
E. Quality Improvement and National Initiatives
• Work with Singapore Hospice Council on national initiatives like guidelines, data sets, surveys, and benchmarking.
• Participate in workgroups or pilot programs led by SHC and MOH.
F. Leadership and Professional Development
• Facilitate quality improvement activities.
• Assist in expanding palliative care services.
• Participate in strategic planning for palliative care.
• Perform other tasks as assigned.
Requirements
• Bachelor's degree in Health Sciences, Nursing, or relevant Allied Health field.
• Experience in a similar setting is preferred.
• Good interpersonal and communication skills, with the ability to work independently and in a team.

Job Description - Manager, Medical Advisor & Case Management (25000C9)

Manager, Medical Advisor & Case Management (Job Number: 25000C9 )

About the Job

To provide medical consultation and opinion in regard to claims pertinent to Guarantee
Letter (GL) or Reimbursement / medical claim disputes or appeals / investigations / underwriting, and to ensure effective implementation of case management intervention in order to efficiently reduce or contain healthcare cost, without compromising healthcare quality and needs, in addition to development of quality assurance programmes or other relevant initiatives for organization.

Medical advisory lead within and beyond operations divisions. To provide medical insights to various divisions within the company such as Medical Claims, Network Management, Call Centre, Customer Services, Product Management & Pricing, Strategic Business
Development etc.

• To monitor and follow up with complex cases that require prolonged stay or due for discharge based on the length of stay planned / benchmarked; with the objective of limiting unwarranted extension of stay without compromising the care quality and to evaluate /approve for Top Up GL that fulfills criteria set within the proposed benchmark.
• To provide medical consultation and opinion in regard to admissibility and necessity of medical claims, fulfilment of policy contract definition in medical claims, investigation and underwriting decisions, as well as ad-hoc medical consultation and opinion in medical
  related queries.
• To communicate with panel specialists via call conference or virtual meetings regarding Professional Fee Queries and address overcharging issues or any issues on specialist’s fees to appropriate parties such as hospital management / hospital fee committee and Ministry of Health (MOH), medical councils, LIAM / PIAM as and when required, in accordance with the PHFSA Fee Schedule and reasonable & customary charges (R&C)
  guides.
• To develop / coach claim assessors through regular medical trainings and development / revision of internal claims guidelines in order to enhance their medical knowledge and competency in claim assessment to deliver services in keeping with the standards set.
• To involve in projects and/or initiatives for department / division process improvement.
• To conduct quality assurance checking on medical claims; to vet through periodical service report and follow up with relevant parties for remedial actions and its implementation as and when required.
• As part of the leadership team, work with key stakeholders to proactively shape the organisation’s culture and conduct environment that is aligned to the organization’s Core Values.
• Takes accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks.
• Maintains awareness of industry trends on regulatory compliance, emerging threats and technologies in order to understand the risk and better safeguard the company’s interest.
• Highlights any potential concerns / risks and proactively shares the best risk management practices.
• In charge of fraud, waste and abuse (FWA) detection, resolution and prevention to minimize billing wastages by reviewing and analyzing trends and emerging patterns in hospital and doctors’ charges, implementing controls on claims overutilization.

• Qualifications: Licensed practicing Medical Doctor (MBBS / MD) in good standing in medical community, preferably with clinical experience / specialty in internal medicine, paediatrics, and surgical based. Postgraduate qualification in occupational health, family medicine, or any relevant field would be an added advantage. Experience in a public / private hospital is essential. Experience in analysis, fraud detection is an added
  advantage.
• Working Experience: Minimum 5 years working experience in healthcare and/or
  insurance.
• Key Skills: Sound medical knowledge; knowledge of healthcare billing and medical terminology; strong business acumen with communication, analytical, problem solving, documentation and organization skills; strong negotiation and public relation skills.
• Key Knowledge: Knowledge in medical terminology, clinical knowledge; Proficiency in current healthcare delivery systems and hospital, patient management and billing system; insurance product and contractual wordings knowledge.
• Key Competencies: Customer service, product knowledge, medical knowledge, information gathering and analysis, policy interpretation and application, processes, procedures and policies.
• Demonstrates alignment with the organisation’s core values through expected behaviours
• High level of integrity, takes accountability of work and good attitude over teamwork.
• Takes initiative to improve current state of circumstances and adaptable to embrace new
  changes.

Who we are

Founded in 1908, Great Eastern is a well-established market leader and trusted brand in Singapore and Malaysia. With over S$100 billion in assets and more than 16 million policyholders, including 12.5 million from government schemes, it provides insurance solutions to customers through three successful distribution channels – a tied agency force, bancassurance, and financial advisory firm Great Eastern Financial Advisers. The Group also operates in Indonesia and Brunei. The Great Eastern Life Assurance Company Limited and Great Eastern General Insurance Limited have been assigned the financial strength and counterparty credit ratings of "AA-" by S&P Global Ratings since 2010, one of the highest among Asian life insurance companies. Great Eastern's asset management subsidiary, Lion Global Investors Limited, is one of the leading asset management companies in Southeast Asia. Great Eastern is a subsidiary of OCBC, the longest established Singapore bank, formed in 1932. It is the second largest financial services group in Southeast Asia by assets and one of the world’s most highly-rated banks, with an Aa1 rating from Moody’s and AA- by both Fitch and S&P. Recognised for its financial strength and stability, OCBC is consistently ranked among the World’s Top 50 Safest Banks by Global Finance and has been named Best Managed Bank in Singapore by The Asian Banker.

To all recruitment agencies: Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or our employees. We will not be responsible for any fees related to unsolicited resumes.

To All Recruitment Agencies Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or our employees. We will not be responsible for any fees related to unsolicited resumes.

GREAT EASTERN WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

GREAT EASTERN WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

1 day ago Be among the first 25 applicants

To provide medical consultation and opinion in regard to claims pertinent to Guarantee Letter (GL) or Reimbursement / medical claim disputes or appeals / investigations / underwriting, and to ensure effective implementation of case management intervention in order to efficiently reduce or contain healthcare cost, without compromising healthcare quality and needs, in addition to development of quality assurance programmes or other relevant initiatives for organization.

• Medical advisory lead within and beyond operations divisions. To provide medical insights to various divisions within the company such as Medical Claims, Network Management, Call Centre, Customer Services, Product Management & Pricing, Strategic Business Development etc.
• To monitor and follow up with complex cases that require prolonged stay or due for discharge based on the length of stay planned / benchmarked; with the objective of limiting unwarranted extension of stay without compromising the care quality and to evaluate / approve for Top Up GL that fulfills criteria set within the proposed benchmark.
• To provide medical consultation and opinion in regard to admissibility and necessity of medical claims, fulfilment of policy contract definition in medical claims, investigation and underwriting decisions, as well as ad-hoc medical consultation and opinion in medical related queries.
• To communicate with panel specialists via call conference or virtual meetings regarding Professional Fee Queries and address overcharging issues or any issues on specialist’s fees to appropriate parties such as hospital management / hospital fee committee and Ministry of Health (MOH), medical councils, LIAM / PIAM as and when required, in accordance with the PHFSA Fee Schedule and reasonable & customary charges (R&C) guides.
• To develop / coach claim assessors through regular medical trainings and development / revision of internal claims guidelines to enhance their medical knowledge and competency in claim assessment to deliver services in keeping with the standards set.
• To involve in projects and/or initiatives for department / division process improvement.
• To conduct quality assurance checking on medical claims; to vet through periodical service report and follow up with relevant parties for remedial actions and its implementation as and when required.
• Take accountability in considering business and regulatory compliance risks and take appropriate steps to mitigate the risks.
• Maintain awareness of industry trends on regulatory compliance, emerging threats and technologies in order to understand the risk and better safeguard the company’s interest.
• Highlight any potential concerns / risks and proactively share the best risk management practices.
• In charge of fraud, waste and abuse (FWA) detection, resolution and prevention to minimize billing wastages by reviewing and analyzing trends and emerging patterns in hospital and doctors’ charges, implementing controls on claims overutilization.

The Person:

• Qualifications: Licensed practicing Medical Doctor (MBBS / MD) in good standing in medical community, preferably with clinical experience/ specialty in internal medicine, paediatrics, and surgical based. Postgraduate qualification in occupational health, family medicine, or any relevant field would be an added advantage. Experience in a public/ private hospital is essential. Experience in analysis, fraud detection is an added advantage.
• Working Experience: Minimum 5 years working experience in healthcare and/or insurance.
• Key Skills: Sound medical knowledge; knowledge of healthcare billing and medical terminology; strong business acumen with communication, analytical, problem solving, documentation and organization skills; strong negotiation and public relation skills.
• Key Knowledge: Knowledge in medical terminology, clinical knowledge; Proficiency in current healthcare delivery systems and hospital, patient management and billing system; insurance product and contractual wordings knowledge.
• Key Competencies: Customer service, product knowledge, medical knowledge, information gathering and analysis, policy interpretation and application, processes, procedures and policies.
• Demonstrate alignment with the organisation’s core values through expected behaviours.
• High level of integrity, take accountability of work and good attitude over teamwork.
• Take initiative to improve current state of circumstances and adaptable to embrace new changes.

How you succeed

• Champion and embody our Core Values in everyday tasks and interactions.
• Demonstrate high level of integrity and accountability.
• Take initiative to drive improvements and embrace change. Ver 1.0
• Take accountability of business and regulatory compliance risks, implementing measures to mitigate them effectively.
• Keep abreast with industry trends, regulatory compliance, and emerging threats and technologies to understand and highlight potential concerns/ risks to safeguard our company proactively.

Who we are

Founded in 1908, Great Eastern is a well-established market leader and trusted brand in Singapore and Malaysia. With over S$100 billion in assets and more than 16 million policyholders, including 12.5 million from government schemes, it provides insurance solutions to customers through three successful distribution channels – a tied agency force, bancassurance, and financial advisory firm Great Eastern Financial Advisers. The Group also operates in Indonesia and Brunei.

The Great Eastern Life Assurance Company Limited and Great Eastern General Insurance Limited have been assigned the financial strength and counterparty credit ratings of "AA-" by S&P Global Ratings since 2010, one of the highest among Asian life insurance companies. Great Eastern's asset management subsidiary, Lion Global Investors Limited, is one of the leading asset management companies in Southeast Asia.

Great Eastern is a subsidiary of OCBC, the longest established Singapore bank, formed in 1932. It is the second largest financial services group in Southeast Asia by assets and one of the world’s most highly-rated banks, with an Aa1 rating from Moody’s and AA- by both Fitch and S&P. Recognised for its financial strength and stability, OCBC is consistently ranked among the World’s Top 50 Safest Banks by Global Finance and has been named Best Managed Bank in Singapore by The Asian Banker.

To all recruitment agencies : Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or our employees. We will not be responsible for any fees related to unsolicited resumes

• Seniority level Mid-Senior level

• Employment type Full-time

• Job function Health Care Provider
• Industries Insurance, Hospitals and Health Care, and Medical Practices

Referrals increase your chances of interviewing at GREAT EASTERN by 2x

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AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

Join to apply for the Medical Advisory, Case & Fraud Management, Specialist role at AIA Malaysia

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AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

Join to apply for the Medical Advisory, Case & Fraud Management, Specialist role at AIA Malaysia

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

• To identify pattern of fraud, waste, and abuse in case management.
• To implement measures required for risk management.
• To conduct surgical and medical history check on claims .
• To identify breach of duty of good faith and non-disclosure
• To ensure risk are priced correctly and non-disclosed conditions excluded accurately and modified
• To perform prospective, concurrent and retrospective review of hospitalization
• To ensure cost containment measures without compromising on the care quality and service standards.
  
  

• To provide Medical Advisory including disputed charges, appeals and critical issues.
• To ensure the Fraud tool is maintained and handled with care with insightful monthly analysis.
• Proficient with medical coding, 13th Schedule, MOH letters, reasonable and customary charges.
• To conduct Amount Under Clarification (AUC) and case management, regular audits, and handle critical issues to identify Fraud, Waste and Abuse.
• To ensure claim adjudication is in accordance with reasonable and customary charges and to review trending of doctors / members / agents that may or may not be in the watch list.
• To outline process improvement, cost saving measures, combating Fraud, Waste, and Abuse methods from audits.
• To build claim guides that collaborates with clinical guides and cost containment with effective implementation.
• To conduct robust medical training aligned with technical aspects of claims processing including training to hospitals.
• To actively engage with collaborators for recovery and remedial actions including doctors under supervision and non-participating list of doctors / agents / hospitals / members.
• To mentor/coach and guide the TLs and assessors in robust decision making. To proactively identify and collaborate on the needful system improvement and process automation.
• To provide timely reporting and communication of all initiatives across all units in AIA.
• To participate and represent Medical Advisory, Case, and Fraud management in all vital initiatives.
  
  

• Candidate must possess at least a Bachelor's Degree or Diploma or equivalent experience
• Min 5 years of medical claim experience
• Technical Skills: Claims assessment, medical report knowledge, Health Insurance Policy knowledge.
• Industry: Insurance, Third-Party Administrator, Hospitals, Clinics, Medical Labs.
• Language: English and Bahasa Malaysia.
  
  

• Seniority level Mid-Senior level

• Employment type Full-time

• Job function Health Care Provider
• Industries Insurance

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Join to apply for the PAMB | Manager, Provider Management & Connected Care role at Prudential Assurance Malaysia Berhad

1 day ago Be among the first 25 applicants

Join to apply for the PAMB | Manager, Provider Management & Connected Care role at Prudential Assurance Malaysia Berhad

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.

Job Title : Manager 2, Health Provider Management & Connected Care – System Lead

Department : Provider Management & Connected Care

Employment Type : Full-Time

Seniority Level : Manager 2

Location : Menara Prudential -TRX

Reports To : Manager 1 of Health Provider Management & Connected Care

At Prudential, we strive to be partners for every life and protectors for every future. Our purpose fuels everything we do, fostering a culture of innovation, diversity, and inclusion. We empower our team members to excel and create meaningful impact through collaboration and leadership.

Role Overview

This role is critical in leading system-related initiatives under the Provider Management & Connected Care team. As Manager 2, you will take charge of system governance, end-to-end project management, and process optimization for tools such as the HAS Portal (PAMB Provider System), OCR, and e-Benefits (EB). You will lead a small but agile team, ensuring seamless user experience, system enhancements, troubleshooting, and training. This role will also manage cross-functional collaboration with IT and vendors, focusing on system stability, enhancements, and innovation.

Key Responsibilities

System & Process Management

• Lead the full cycle of system enhancements, from gathering business requirements to deployment and post-go-live support.
• Drive User Acceptance Testing (UAT), Operational Readiness Testing (ORT), and Disaster Recovery (DR) tests. Prepare test scripts, test scenarios, and review results.
• Collaborate with IT and vendors to translate business needs into Functional Specification Documents (FSDs).
• Manage and monitor the HAS Portal, ensuring system performance, troubleshooting, and stakeholder satisfaction.
• Coordinate and manage OCR and e-Benefit (EB) systems to support seamless claims, verification, and reporting processes.
• Stakeholder & Vendor Management - Act as the main liaison between the business unit, IT, and third-party vendors.
• Facilitate requirement walkthroughs with technical teams and stakeholders to align expectations.
• Oversee vendor performance to ensure timely and quality delivery of system upgrades and fixes.
• Lead, coach, and mentor two system specialists, ensuring alignment with department goals and skill development.
• Conduct knowledge-sharing sessions and lead training programs related to system usage and enhancements.
• Reporting & Governance - Prepare progress reports, dashboards, and system issue logs for internal governance meetings.
• Ensure system compliance, audit readiness, and documentation accuracy.
• ---
  
  
  

• Bachelor’s degree in IT, Business Information Systems, Health Informatics, or a related field.
• Minimum 3–5 years of experience in system-related roles, preferably within healthcare or insurance.
• Proven experience in managing UAT, ORT, system walk-throughs, and end-to-end project management.
• Strong knowledge of system development lifecycle (SDLC), user training, and vendor coordination.
• Experience preparing and reviewing Functional Specification Documents (FSDs).
• Excellent communication, stakeholder engagement, and team leadership skills.
• Familiarity with OCR, e-invoice/billing integrated platforms, and hospital/provider-related systems is an advantage.
  
  
  

• Project management certification (e.g., PMP, PRINCE2) is an added advantage.
• Strong in system management and problem-solving capabilities.
• Proficiency in Microsoft Office tools (Excel, Word, PowerPoint) and project tracking software.
  
  
  

• Seniority level Mid-Senior level

• Employment type Full-time

• Job function Other

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