What Jobs are available for Care Planning in Malaysia?
Showing 6 Care Planning jobs in Malaysia
Executive, Case Management Unit
Sepang
Malaysian Communication and Multimedia Commission (MCMC)
Posted 4 days ago
Job Viewed
Job Description
Overview Evaluate and escalate online content complaints and cybercrime incidents relating to the Communications and Multimedia Act 1998 (CMA 1998) received from all channels, including the Aduan Portal, for administrative or enforcement actions under the CMA 98, within a stipulated timeline, to ensure high standards of customer service delivery, as well as maintaining a safe, positive, and conducive online environment for all.
Job Responsibilities
Complaint Acknowledgment: Acknowledge receipt of complaints and request additional information within three (3) working days to reassure complainants that their complaints are being addressed.
Information Gathering: Gather necessary information and supporting documents to establish a comprehensive and factual basis for appropriate action.
Content Analysis and Legal Assessment: Conduct detailed analysis of online content against the CMA 1998, other written laws, and the CMCF Content Code to ensure effective complaint management and safeguard complainants' rights, and identify elements of violation to enable informed decision-making.
Action Recommendations: Develop actionable recommendations based on the analysis and evaluation of complaints and submit them to Team Leaders for approval and further action.
Liaison with internal departments and platforms on Escalation of Complaints: Prepare detailed escalation analysis for second-tier internal departments (such as enforcement) to ensure informed and efficient decision-making.
Documentation and Evidence Management: Work with the internal department to gather and preserve evidence in compliance with legal protocols, ensuring it is suitable for use in court or other proceedings, and keep detailed records of all evidence, statements, and interactions related to the case.
Coordination with Online Service Providers (OSPs): Upon confirmation of an offense, initiate further action as required. If the offense violates community guidelines and the complainant requests removal, escalate the matter to the relevant OSP.
Documentation and Reporting: Maintain accurate and detailed records of all actions taken, including communications with the internal department and OSPs, and prepare reports for internal review and records.
Public Interaction and Trust Building: Respond promptly to public inquiries and questions to build trust and uphold the organization's reputation, ensuring complainants are heard, respected, and supported throughout the process.
Timely Resolution and Case Management: Ensure complaints are resolved within the stipulated timeframe by updating online content cases to prevent delays and maintain transparency.
Collaboration and Process Improvement: Foster collaboration with internal and external stakeholders to resolve issues and continuously review and refine case management practices to enhance efficiency and alignment with organizational goals.
Guidance and Support for Complainants: Provide complainants with clear information about potential next steps, including legal options or enforcement actions, depending on case severity and evidence.
Qualifications & Work Experience
Bachelor’s Degree in Mass Communication, Information Systems, Law, or related qualifications from a recognized university.
Minimum 2 years of working experience, with strong knowledge of technology and online content, and understanding of legal and regulatory frameworks.
Analytical reporting skills
Technical analysis skills
Project and resource management
Knowledge of legal, regulatory, and governance framework
Understanding of enforcement and compliance requirements
Internet, open source, and web intelligence skills
Content review and analysis
Complaint management and information gathering
Public speaking/presentation skills
Collaboration and teamwork
Conflict resolution and patience
Attention to detail and organizational skills
Conceptual and analytical thinking
Interpersonal skills and ability to multitask
Willingness to work in Cyberjaya
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Job Responsibilities
Complaint Acknowledgment: Acknowledge receipt of complaints and request additional information within three (3) working days to reassure complainants that their complaints are being addressed.
Information Gathering: Gather necessary information and supporting documents to establish a comprehensive and factual basis for appropriate action.
Content Analysis and Legal Assessment: Conduct detailed analysis of online content against the CMA 1998, other written laws, and the CMCF Content Code to ensure effective complaint management and safeguard complainants' rights, and identify elements of violation to enable informed decision-making.
Action Recommendations: Develop actionable recommendations based on the analysis and evaluation of complaints and submit them to Team Leaders for approval and further action.
Liaison with internal departments and platforms on Escalation of Complaints: Prepare detailed escalation analysis for second-tier internal departments (such as enforcement) to ensure informed and efficient decision-making.
Documentation and Evidence Management: Work with the internal department to gather and preserve evidence in compliance with legal protocols, ensuring it is suitable for use in court or other proceedings, and keep detailed records of all evidence, statements, and interactions related to the case.
Coordination with Online Service Providers (OSPs): Upon confirmation of an offense, initiate further action as required. If the offense violates community guidelines and the complainant requests removal, escalate the matter to the relevant OSP.
Documentation and Reporting: Maintain accurate and detailed records of all actions taken, including communications with the internal department and OSPs, and prepare reports for internal review and records.
Public Interaction and Trust Building: Respond promptly to public inquiries and questions to build trust and uphold the organization's reputation, ensuring complainants are heard, respected, and supported throughout the process.
Timely Resolution and Case Management: Ensure complaints are resolved within the stipulated timeframe by updating online content cases to prevent delays and maintain transparency.
Collaboration and Process Improvement: Foster collaboration with internal and external stakeholders to resolve issues and continuously review and refine case management practices to enhance efficiency and alignment with organizational goals.
Guidance and Support for Complainants: Provide complainants with clear information about potential next steps, including legal options or enforcement actions, depending on case severity and evidence.
Qualifications & Work Experience
Bachelor’s Degree in Mass Communication, Information Systems, Law, or related qualifications from a recognized university.
Minimum 2 years of working experience, with strong knowledge of technology and online content, and understanding of legal and regulatory frameworks.
Analytical reporting skills
Technical analysis skills
Project and resource management
Knowledge of legal, regulatory, and governance framework
Understanding of enforcement and compliance requirements
Internet, open source, and web intelligence skills
Content review and analysis
Complaint management and information gathering
Public speaking/presentation skills
Collaboration and teamwork
Conflict resolution and patience
Attention to detail and organizational skills
Conceptual and analytical thinking
Interpersonal skills and ability to multitask
Willingness to work in Cyberjaya
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0
Assistant Manager (Arbitrator & Case Management)
Kelantan, Kelantan
RAPSYS TECHNOLOGIES PTE. LTD.
Posted 2 days ago
Job Viewed
Job Description
Location:
Colaba Mumbai Employment Type:
Full-time | Work from office Reports to:
Chief of Staff / Manager – Case & Communications Management / Head – Legal Operations
Role Overview We are seeking a dedicated and experienced professional to oversee the onboarding, engagement, and management of arbitrators empaneled with our platform. This individual will serve as the primary point of contact for arbitrators, ensuring smooth onboarding, effective training, continuous engagement, and ongoing support. The role also involves coordinating arbitrator activities, managing communication, and maintaining updated records.
Key Responsibilities
Identify and source potential arbitrators for empanelment.
Manage the end-to-end onboarding process of arbitrators, including process explanation, responsibilities, fee structure, case handling guidelines, and documentation.
Conduct training sessions for newly empaneled arbitrators on platform usage.
Organize quarterly refresher trainings and workshops for existing arbitrators.
Develop and maintain training resources, manuals, FAQs, and other support materials.
Act as the key liaison between the organization and arbitrators for ongoing disputes.
Coordinate with arbitrators to schedule hearings and facilitate the issuance of orders.
Facilitate smooth communication by creating and managing WhatsApp groups.
Maintain and update databases of arbitrators, training sessions, and certifications.
Engage with arbitrators regularly to gather feedback and implement improvements.
Skills & Qualifications
Bachelor’s degree in Law (LLB), Commerce (B.Com), Management (BMS), or a related field.
Minimum 1 year of post-qualification experience in stakeholder management, training, legal, or arbitration roles.
Strong communication and interpersonal skills with the ability to engage senior professionals.
Excellent organizational and coordination skills with a keen eye for detail.
Strong analytical, problem-solving, written, and verbal communication abilities.
Ability to work independently and proactively in a fast-paced environment.
Proficiency in MS Word, Excel, and PowerPoint.
Tech-savvy, with the ability to quickly adapt to new tools and systems.
Proactive approach towards learning and staying updated on laws and regulations.
Passionate, enterprising, resilient, and perseverant, with a "never give up" attitude.
Willingness to go beyond the call of duty, take initiative, and contribute to process improvements.
#J-18808-Ljbffr
Colaba Mumbai Employment Type:
Full-time | Work from office Reports to:
Chief of Staff / Manager – Case & Communications Management / Head – Legal Operations
Role Overview We are seeking a dedicated and experienced professional to oversee the onboarding, engagement, and management of arbitrators empaneled with our platform. This individual will serve as the primary point of contact for arbitrators, ensuring smooth onboarding, effective training, continuous engagement, and ongoing support. The role also involves coordinating arbitrator activities, managing communication, and maintaining updated records.
Key Responsibilities
Identify and source potential arbitrators for empanelment.
Manage the end-to-end onboarding process of arbitrators, including process explanation, responsibilities, fee structure, case handling guidelines, and documentation.
Conduct training sessions for newly empaneled arbitrators on platform usage.
Organize quarterly refresher trainings and workshops for existing arbitrators.
Develop and maintain training resources, manuals, FAQs, and other support materials.
Act as the key liaison between the organization and arbitrators for ongoing disputes.
Coordinate with arbitrators to schedule hearings and facilitate the issuance of orders.
Facilitate smooth communication by creating and managing WhatsApp groups.
Maintain and update databases of arbitrators, training sessions, and certifications.
Engage with arbitrators regularly to gather feedback and implement improvements.
Skills & Qualifications
Bachelor’s degree in Law (LLB), Commerce (B.Com), Management (BMS), or a related field.
Minimum 1 year of post-qualification experience in stakeholder management, training, legal, or arbitration roles.
Strong communication and interpersonal skills with the ability to engage senior professionals.
Excellent organizational and coordination skills with a keen eye for detail.
Strong analytical, problem-solving, written, and verbal communication abilities.
Ability to work independently and proactively in a fast-paced environment.
Proficiency in MS Word, Excel, and PowerPoint.
Tech-savvy, with the ability to quickly adapt to new tools and systems.
Proactive approach towards learning and staying updated on laws and regulations.
Passionate, enterprising, resilient, and perseverant, with a "never give up" attitude.
Willingness to go beyond the call of duty, take initiative, and contribute to process improvements.
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1
Client Lifecycle Management - KYC Case Management Analyst (AVP)
Kuala Lumpur, Kuala Lumpur
Deutsche Bank
Posted 16 days ago
Job Viewed
Job Description
Client Lifecycle Management - KYC Case Management Analyst (AVP) Overview The KYC APAC Regional Case Management team plays an important role in APAC KYC Ops, collaborating with KYC production teams to ensure KYC reviews and remediation are conducted timely and in compliance with regulatory requirements. The team provides robust governance and tight tracking to ensure monthly KPIs are met, through close collaboration with regional branches (production team).
What we will offer you A healthy, engaged and well-supported workforce is better equipped to do their best work and, more importantly, enjoy their lives inside and outside the workplace. Deutsche Bank is committed to providing an environment with your development and wellbeing at its center.
Flexi Work Arrangement
Competitive salary
Medical and life insurance coverage
Annual leave
26 weeks of Primary Caregiver leave and 16 weeks of Non-Primary Caregiver leave
Your Key Responsibilities The key tasks of this role include, but are not limited to the following:
KYC Case Management and Analysis
Perform KYC progression analysis for generating reports on a periodic basis
Blocker clearance – connect with production and provide guidance to resolve challenges that block progress
Investigate and analyze data to translate it into meaningful reports
Prioritize streams of review (HR, LR20%, NRD, RHP, etc.)
Offline completion processing
Problem Solving & Production Process Improvement
Understand key stakeholder KYC review and remediation challenges and provide appropriate KYC technical resolutions (strategic and tactical as appropriate)
Analyze available KYC business information from existing tools to identify opportunities to improve timeliness and productivity
Participate in regional KYC production meetings to resolve blockers and share governance updates
MIS Function
Coordinate with regional production teams and Data MI Analysts to gather data requirements, support data quality, and establish data management and data governance processes
Generate and distribute management reports accurately and timely when needed
Serve as the go-to person for MIS artefacts available to production teams to facilitate smooth operations and maintenance
Ensure traceability of data and perform deep dives to resolve issues, self-solving or collaborating with stakeholders
Provide recommendations to update MIS to improve reporting efficiency and consistency
Provide strong reporting and analytical support to management
Coordinate the generation of periodic and ad hoc reports as needed
Suggest Tableau Dashboard builds when required for monitoring KYC operations performance
Provide timely SQL-based information extraction when needed
Other coverage Full KYC end-to-end exposure and participation in supporting files review in progress, missing in transition and backend correction through Break Resolution Forum.
Skills and Experience
KYC experience across multiple jurisdictions (where possible)
Business process improvement experience with strong root-cause analysis
Analytical mindset with ability to interpret data and statistics to inform strategy
Data modelling — integrate data from multiple sources to standards and best practices
Statistical knowledge — analyze historical data for forecasting and root cause analysis
Interpersonal skills — ability to interact with stakeholders to implement technology solutions and process improvements
Strong writing skills for complex reports and analysis
Experience with data tools (preferred but not mandatory): Tableau/Power BI, SQL, Alteryx/Looker, Python, Excel and Access/VBA, Power Platform
Educational and Other Qualifications
Bachelor's degree in Business Administration, Finance, or related field
Experience in banking with strong KYC knowledge
Analytical and problem-solving skills with strong written and verbal communication
5+ years of experience in KYC with exposure to MI, Data Analytics, or related field
Strong analytical and problem-solving abilities
Excellent communication and presentation skills
Ability to work independently and as part of a team
Strong understanding of business principles and practices
Proficiency in Microsoft Office, SQL, and Power BI
How we’ll support you
Coaching and support from experts in your team
A culture of continuous learning to aid progression
Training and development to help you excel in your career
About Deutsche Bank and Diversity Deutsche Bank is a leading German bank with strong European roots and a global network. We value diversity and inclusion and are committed to creating a working environment that is diverse, supportive and welcoming of different views. We promote flexible work arrangements and initiatives to support employee wellbeing and development. We strive to create a culture where people can excel together, act responsibly, think commercially, take initiative and collaborate. We welcome applications from all backgrounds and are committed to a positive, fair, and inclusive work environment.
Seniority level
Not Applicable
Employment type
Full-time
Job function
Management and Manufacturing
#J-18808-Ljbffr
What we will offer you A healthy, engaged and well-supported workforce is better equipped to do their best work and, more importantly, enjoy their lives inside and outside the workplace. Deutsche Bank is committed to providing an environment with your development and wellbeing at its center.
Flexi Work Arrangement
Competitive salary
Medical and life insurance coverage
Annual leave
26 weeks of Primary Caregiver leave and 16 weeks of Non-Primary Caregiver leave
Your Key Responsibilities The key tasks of this role include, but are not limited to the following:
KYC Case Management and Analysis
Perform KYC progression analysis for generating reports on a periodic basis
Blocker clearance – connect with production and provide guidance to resolve challenges that block progress
Investigate and analyze data to translate it into meaningful reports
Prioritize streams of review (HR, LR20%, NRD, RHP, etc.)
Offline completion processing
Problem Solving & Production Process Improvement
Understand key stakeholder KYC review and remediation challenges and provide appropriate KYC technical resolutions (strategic and tactical as appropriate)
Analyze available KYC business information from existing tools to identify opportunities to improve timeliness and productivity
Participate in regional KYC production meetings to resolve blockers and share governance updates
MIS Function
Coordinate with regional production teams and Data MI Analysts to gather data requirements, support data quality, and establish data management and data governance processes
Generate and distribute management reports accurately and timely when needed
Serve as the go-to person for MIS artefacts available to production teams to facilitate smooth operations and maintenance
Ensure traceability of data and perform deep dives to resolve issues, self-solving or collaborating with stakeholders
Provide recommendations to update MIS to improve reporting efficiency and consistency
Provide strong reporting and analytical support to management
Coordinate the generation of periodic and ad hoc reports as needed
Suggest Tableau Dashboard builds when required for monitoring KYC operations performance
Provide timely SQL-based information extraction when needed
Other coverage Full KYC end-to-end exposure and participation in supporting files review in progress, missing in transition and backend correction through Break Resolution Forum.
Skills and Experience
KYC experience across multiple jurisdictions (where possible)
Business process improvement experience with strong root-cause analysis
Analytical mindset with ability to interpret data and statistics to inform strategy
Data modelling — integrate data from multiple sources to standards and best practices
Statistical knowledge — analyze historical data for forecasting and root cause analysis
Interpersonal skills — ability to interact with stakeholders to implement technology solutions and process improvements
Strong writing skills for complex reports and analysis
Experience with data tools (preferred but not mandatory): Tableau/Power BI, SQL, Alteryx/Looker, Python, Excel and Access/VBA, Power Platform
Educational and Other Qualifications
Bachelor's degree in Business Administration, Finance, or related field
Experience in banking with strong KYC knowledge
Analytical and problem-solving skills with strong written and verbal communication
5+ years of experience in KYC with exposure to MI, Data Analytics, or related field
Strong analytical and problem-solving abilities
Excellent communication and presentation skills
Ability to work independently and as part of a team
Strong understanding of business principles and practices
Proficiency in Microsoft Office, SQL, and Power BI
How we’ll support you
Coaching and support from experts in your team
A culture of continuous learning to aid progression
Training and development to help you excel in your career
About Deutsche Bank and Diversity Deutsche Bank is a leading German bank with strong European roots and a global network. We value diversity and inclusion and are committed to creating a working environment that is diverse, supportive and welcoming of different views. We promote flexible work arrangements and initiatives to support employee wellbeing and development. We strive to create a culture where people can excel together, act responsibly, think commercially, take initiative and collaborate. We welcome applications from all backgrounds and are committed to a positive, fair, and inclusive work environment.
Seniority level
Not Applicable
Employment type
Full-time
Job function
Management and Manufacturing
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2
Medical Advisory, Case & Fraud Management, Specialist
Kuala Lumpur, Kuala Lumpur
AIA Hong Kong
Posted 16 days ago
Job Viewed
Job Description
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. WE ARE LOOKING FOR . Responsible for performing pre-certification; prospective, concurrent, and retrospective review of hospitalization; and to ensure cost containment measures are carried out without compromising on the care quality and service standards
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 Achieve team target Savings benchmark 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 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.
#J-18808-Ljbffr
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 Achieve team target Savings benchmark 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 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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3
Medical Advisory, Case & Fraud Management, Specialist
Kuala Lumpur, Kuala Lumpur
AIA Malaysia
Posted 16 days ago
Job Viewed
Job Description
Medical Advisory, Case & Fraud Management, Specialist
AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Join or sign in to find your next job
Join to apply for the
Medical Advisory, Case & Fraud Management, Specialist
role at
AIA Malaysia Continue with Google Continue with Google Medical Advisory, Case & Fraud Management, Specialist
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.
Job Responsibilities
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.
Minimum Job Requirements
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.
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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Insurance Referrals increase your chances of interviewing at AIA Malaysia by 2x Sign in to set job alerts for “Medical Specialist” roles.
Continue with Google Continue with Google Continue with Google Continue with Google Petaling Jaya, Selangor, Malaysia 2 days ago Federal Territory of Kuala Lumpur, Malaysia 1 week ago Malay OPIVRI Medical Interpretation Vacancy
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AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Join or sign in to find your next job
Join to apply for the
Medical Advisory, Case & Fraud Management, Specialist
role at
AIA Malaysia Continue with Google Continue with Google Medical Advisory, Case & Fraud Management, Specialist
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.
Job Responsibilities
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.
Minimum Job Requirements
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.
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. Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Insurance Referrals increase your chances of interviewing at AIA Malaysia by 2x Sign in to set job alerts for “Medical Specialist” roles.
Continue with Google Continue with Google Continue with Google Continue with Google Petaling Jaya, Selangor, Malaysia 2 days ago Federal Territory of Kuala Lumpur, Malaysia 1 week ago Malay OPIVRI Medical Interpretation Vacancy
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Asia Care Coordinator
Kuala Lumpur, Kuala Lumpur
AM Healthcare Management Consulting Sdn. Bhd.
Posted 1 day ago
Job Viewed
Job Description
Teladoc Health (NYE: TDOC) is recognized as a global leader in whole-person virtual care offering comprehensive solutions in telehealth, expert medical opinion, behaviour health and preventative care services, serving over 100 million members across 175+ countries in 40+ languages.
Role and Responsibilities
Answer client and patient calls in a professional manner;
Assign cases to physicians;
Follow up customer needs to improve service satisfaction.
Help communicate with relevant institutions to obtain necessary medical materials and data.
Help communicate with different accounts to support account management.
Administrative support.
Skills and Background Requirements
Good communication and people skills to interact with internal stakeholders and external stakeholders such as our customers;
Fluent in both English and Mandarin Chinese;
Tech-savvy, familiar with computer and Microsoft Office;
Fast learner, good team worker, good patience, high sense of responsibility.
Working Arrangements (Rotational Shift) Weekday work hours in office: 9am-6pm, 10am-7pm, or 12pm-9pm.
Work with a global leader in telehealth and virtual care.
Contribute to innovative health programs that improve patient outcomes.
Collaborate with a diverse and multidisciplinary healthcare team.
#J-18808-Ljbffr
Role and Responsibilities
Answer client and patient calls in a professional manner;
Assign cases to physicians;
Follow up customer needs to improve service satisfaction.
Help communicate with relevant institutions to obtain necessary medical materials and data.
Help communicate with different accounts to support account management.
Administrative support.
Skills and Background Requirements
Good communication and people skills to interact with internal stakeholders and external stakeholders such as our customers;
Fluent in both English and Mandarin Chinese;
Tech-savvy, familiar with computer and Microsoft Office;
Fast learner, good team worker, good patience, high sense of responsibility.
Working Arrangements (Rotational Shift) Weekday work hours in office: 9am-6pm, 10am-7pm, or 12pm-9pm.
Work with a global leader in telehealth and virtual care.
Contribute to innovative health programs that improve patient outcomes.
Collaborate with a diverse and multidisciplinary healthcare team.
#J-18808-Ljbffr
Is this job a match or a miss?
This advertiser has chosen not to accept applicants from your region.
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