33 Medical Management jobs in Malaysia

Manager, Medical Advisory & Case Management (Medical Services)

Kuala Lumpur, Kuala Lumpur GREAT EASTERN

Posted 11 days ago

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Job Description

Manager, Medical Advisory & Case Management (Medical Services)

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

Manager, Medical Advisory & Case Management (Medical Services)

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
  • Seniority level Mid-Senior level
Employment type
  • Employment type Full-time
Job function
  • 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

Get notified about new Medical Case Manager jobs in WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia .

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

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Manager, Medical Advisory & Case Management (Medical Services)

Kuala Lumpur, Kuala Lumpur GREAT EASTERN

Posted today

Job Viewed

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Job Description

Manager, Medical Advisory & Case Management (Medical Services)

GREAT EASTERN WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia Manager, Medical Advisory & Case Management (Medical Services)

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

Seniority level Mid-Senior level Employment type

Employment type Full-time Job function

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 Get notified about new Medical Case Manager jobs in

WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia . We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

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This advertiser has chosen not to accept applicants from your region.

Manager, Medical Advisor & Case Management

Kuala Lumpur, Kuala Lumpur Great Eastern Life

Posted 6 days ago

Job Viewed

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Job Description

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.

We are looking for people who
  • 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.

#J-18808-Ljbffr
This advertiser has chosen not to accept applicants from your region.

Academic PhD Consultant (Computer Science, Business Management & Medical)

Proofreading by a UK PhD

Posted 8 days ago

Job Viewed

Tap Again To Close

Job Description

This job is a freelance Academic PhD Consultant where you assist with thesis and publication development from home. You might like this job because it offers flexibility and values your expert knowledge in complex areas like computer science and business!

  • Education level: Master/ PhD in Computer Science, Business Management and Medical
  • Internationals and Locals are welcome to apply
  • Carry out Consultation for PhD/Masters Theses and Publications
  • Specifically, consulting on Thesis and Publication development

***Added Advantage:

-Consulting on Qualitative analysis (Atlas. ti, NVIVO, or manual)

-Consulting on Quantitative analysis (SPSS, SmartPLS, AMOS)

-Able to do Formatting and Referencing

-Candidate with solid Scopus/WoS publications

Job Requirements Right to Work Requirements
  • Candidates with an existing right to work in the country are preferred
  • Local citizens of this country
  • Permanent residents (PR) of this country
  • Candidates who already have a work permit for this country
Working Arrangement
  • Remote
Skills

Qualitative Research

Quantitative Analysis

Data Analysis

Scopus

SPSS (Statistical Software)

ATLAS.ti (Qualitative Data Analysis Software)

Proofreading

Consulting

Company Benefits Coaching and training

You will be monitored by our senior editor to achieve our editing standard

More editing, more earning

You can earn more with editing by providing high-quality end service over time

You can work whenever you want as long as you deliver the job on time

Proofreading BY A UK PHD provides clients with fast, reliable, and affordable language and consultancy services. As a result, enabling new job opportunities for many PhD experts and to utilize their expertise by consulting the clients from a niche segment and as well as earning a solid wage.

#J-18808-Ljbffr
This advertiser has chosen not to accept applicants from your region.

Academic PhD Consultant (Computer Science, Business Management & Medical)

Cyberjaya Proofreading by a UK PhD

Posted today

Job Viewed

Tap Again To Close

Job Description

This job is a freelance Academic PhD Consultant where you assist with thesis and publication development from home. You might like this job because it offers flexibility and values your expert knowledge in complex areas like computer science and business! Education level: Master/ PhD in Computer Science, Business Management and Medical Internationals and Locals are welcome to apply Carry out Consultation for PhD/Masters Theses and Publications Specifically, consulting on Thesis and Publication development ***Added Advantage: -Consulting on Qualitative analysis (Atlas. ti, NVIVO, or manual) -Consulting on Quantitative analysis (SPSS, SmartPLS, AMOS) -Able to do Formatting and Referencing -Candidate with solid Scopus/WoS publications Job Requirements

Right to Work Requirements

Candidates with an existing right to work in the country are preferred Local citizens of this country Permanent residents (PR) of this country Candidates who already have a work permit for this country Working Arrangement

Remote Skills

Qualitative Research Quantitative Analysis Data Analysis Scopus SPSS (Statistical Software) ATLAS.ti (Qualitative Data Analysis Software) Proofreading Consulting Company Benefits

Coaching and training

You will be monitored by our senior editor to achieve our editing standard More editing, more earning

You can earn more with editing by providing high-quality end service over time You can work whenever you want as long as you deliver the job on time Proofreading BY A UK PHD provides clients with fast, reliable, and affordable language and consultancy services. As a result, enabling new job opportunities for many PhD experts and to utilize their expertise by consulting the clients from a niche segment and as well as earning a solid wage.

#J-18808-Ljbffr
This advertiser has chosen not to accept applicants from your region.

Medical Advisory, Case & Fraud Management, Specialist

Kuala Lumpur, Kuala Lumpur AIA Malaysia

Posted 11 days ago

Job Viewed

Tap Again To Close

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

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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

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Medical Advisory, Case & Fraud Management, Specialist

Kuala Lumpur, Kuala Lumpur AIA Malaysia

Posted today

Job Viewed

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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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Clinical Data Management Specialist

HiRO - Harvest Integrated Research Organization

Posted 11 days ago

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Job Description

Harvest Integrated Research Organization (HiRO) is a globally-oriented, innovative boutique CRO dedicated to elevating cross-border clinical trial pathways. As an emerging global CRO, HiRO collaborates closely with biotech and pharmaceutical companies, aiming to efficiently bridge the gap between laboratory research and market commercialization. Our Team Members are curious and determined, always looking to transform challenges into opportunities. Our mission is to provide cutting-edge and capital-efficient solutions, ultimately benefiting patients worldwide.

Job Title: Data Science Specialist

Location: Menara Boustead,Penang,Malaysia

Job Overview:

Serve in entry-level capacity on a Clinical Data Management and Clinical Data Programming team to provide efficient, quality data management and programming services that meet customer needs.

Qualifications

• 0 - 1 years of experience including clinical trials experience in a function similar to DM or Programming. Equivalent combination of education, training and experience.

• Excellent organizational, communication and computer skills required.

• Ability to exercise excellent attention to detail.

• Aptitude for mathematical calculations

• Ability to act independently and with initiative required to resolving problems.

• Ability to establish and maintain effective working relationships with coworkers, managers and clients.

Essential Functions:

• Conduct basic data review.

• Write & Resolve data clarifications with guidance from senior staff.

• Conduct basic quality control procedures.

• Plan and coordinate database design, development, implementation, maintenance, and user support of clinical systems with guidance from senior staff.

• Program, test, and document databases in accordance with programming standards and validation procedures with guidance from senior staff.

• Program database manipulation and transfers of data for internal and external clients with guidance from senior staff.

• Perform and plan: (i) the programming, testing, and documentation of programs for use in creating statistical tables and listing summaries, (ii) the programming of analysis databases (derived datasets) and transfers of data for internal and external clients and (iii) the programming of database quality control checks.

• May program the integration of databases from multiple studies or sources, under supervision.

• Develop programming documentation including specifications, as appropriate, under supervision.

• Provide advanced technical expertise in conjunction with internal and external clients, and bring project solutions to teams and department, under supervision.

• Develop, implement and validate new process technologies, macros and applications under supervision.

• Understand basic database structures.

• Meet personal project objectives, as assigned by manager.

• Meet objectives as assigned and interact with the project team to organize timelines, responsibilities and deliverables.

• Escalate problems to the attention of the Data Science Project Lead or Manager.

• Understand and comply with core operating procedures and working instructions.

• Understand, provide input to and comply with all applicable sections of Project Plan & Specification.

• Develop and maintain good communications and working relationships with Data Science team.

Language Skills

Excellent English written and oral communication skills.

Chinese-English bilingual

Education Required

Bachelor or Above; Pharmacy, medical, nursing, life sciences, statistics, computer science or related field qualification or educational equivalent

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Clinical Data Management Specialist

George Town HiRO - Harvest Integrated Research Organization

Posted today

Job Viewed

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Job Description

Harvest Integrated Research Organization

(HiRO) is a globally-oriented, innovative boutique CRO dedicated to elevating cross-border clinical trial pathways. As an emerging global CRO, HiRO collaborates closely with biotech and pharmaceutical companies, aiming to efficiently bridge the gap between laboratory research and market commercialization. Our Team Members are curious and determined, always looking to transform challenges into opportunities. Our mission is to provide cutting-edge and capital-efficient solutions, ultimately benefiting patients worldwide. Job Title:

Data Science Specialist Location:

Menara Boustead,Penang,Malaysia Job Overview: Serve in entry-level capacity on a Clinical Data Management and Clinical Data Programming team to provide efficient, quality data management and programming services that meet customer needs. Qualifications • 0 - 1 years of experience including clinical trials experience in a function similar to DM or Programming. Equivalent combination of education, training and experience. • Excellent organizational, communication and computer skills required. • Ability to exercise excellent attention to detail. • Aptitude for mathematical calculations • Ability to act independently and with initiative required to resolving problems. • Ability to establish and maintain effective working relationships with coworkers, managers and clients. Essential Functions: • Conduct basic data review. • Write & Resolve data clarifications with guidance from senior staff. • Conduct basic quality control procedures. • Plan and coordinate database design, development, implementation, maintenance, and user support of clinical systems with guidance from senior staff. • Program, test, and document databases in accordance with programming standards and validation procedures with guidance from senior staff. • Program database manipulation and transfers of data for internal and external clients with guidance from senior staff. • Perform and plan: (i) the programming, testing, and documentation of programs for use in creating statistical tables and listing summaries, (ii) the programming of analysis databases (derived datasets) and transfers of data for internal and external clients and (iii) the programming of database quality control checks. • May program the integration of databases from multiple studies or sources, under supervision. • Develop programming documentation including specifications, as appropriate, under supervision. • Provide advanced technical expertise in conjunction with internal and external clients, and bring project solutions to teams and department, under supervision. • Develop, implement and validate new process technologies, macros and applications under supervision. • Understand basic database structures. • Meet personal project objectives, as assigned by manager. • Meet objectives as assigned and interact with the project team to organize timelines, responsibilities and deliverables. • Escalate problems to the attention of the Data Science Project Lead or Manager. • Understand and comply with core operating procedures and working instructions. • Understand, provide input to and comply with all applicable sections of Project Plan & Specification. • Develop and maintain good communications and working relationships with Data Science team. Language Skills Excellent English written and oral communication skills. Chinese-English bilingual Education Required Bachelor or Above; Pharmacy, medical, nursing, life sciences, statistics, computer science or related field qualification or educational equivalent

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Supervisor, Clinical Waste Management (Kamunting, Perak)

Perak, Perak UEM Edgenta Berhad

Posted 11 days ago

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Job Description

Supervisor, Clinical Waste Management (Kamunting, Perak)

Join to apply for the Supervisor, Clinical Waste Management (Kamunting, Perak) role at UEM Edgenta Berhad

Supervisor, Clinical Waste Management (Kamunting, Perak)

1 month ago Be among the first 25 applicants

Join to apply for the Supervisor, Clinical Waste Management (Kamunting, Perak) role at UEM Edgenta Berhad

  • Supervise CWM operations in terms of physical clinical waste movement at site. Conduct data gathering, preparation and analysis for CWM operations inclusive of receiving, processing, disposal and transferring of clinical waste
  • Supervise management of CWM data in system
  • Deal with transporter and private customers related to clinical waste collection schedule
  • Monitor and track clinical waste data throughout the entire chain, starting from the waste receiving, storage, disposal, and backlog.
  • Responsible in receiving, processing, and updating of consignment note data and conduct data entry in eSWIS and ASIS
  • Make arrangement with third party transporter for clinical waste transportation process which for MOH hospitals and private customers
  • Conduct submission of accurate monthly data to account and finance department for billing purposes
  • Ensure accurate data tallied with the actual weight of clinical waste movement at site


Job Description

Job responsibilities:

  • Supervise CWM operations in terms of physical clinical waste movement at site. Conduct data gathering, preparation and analysis for CWM operations inclusive of receiving, processing, disposal and transferring of clinical waste
  • Supervise management of CWM data in system
  • Deal with transporter and private customers related to clinical waste collection schedule
  • Monitor and track clinical waste data throughout the entire chain, starting from the waste receiving, storage, disposal, and backlog.
  • Responsible in receiving, processing, and updating of consignment note data and conduct data entry in eSWIS and ASIS
  • Make arrangement with third party transporter for clinical waste transportation process which for MOH hospitals and private customers
  • Conduct submission of accurate monthly data to account and finance department for billing purposes
  • Ensure accurate data tallied with the actual weight of clinical waste movement at site


Job Requirements:

  • Post Graduate Certificate / Diploma specialised in Clinical Waste management
  • At least 1 - 3 Year(s) of working experience in the related field is required for this position
  • Data conscience and data driven
  • Able to interact with all level personnel
  • Independent and adept at working in groups, with the ability to interact with all levels of personnel.


About Us

UEM Edgenta is the region’s leading Asset Management & Infrastructure Solutions company. We are listed on Bursa Malaysia (KLSE: EDGENTA) with a clear vision to Optimise Assets and Improve Lives.

We promise the Edgenta Way of delivering quality services to our clients by going beyond standards and offering technology-based solutions as a promise of efficiency, anchored upon a mindset to ensure safety across our operations for the benefit of all our stakeholders.

Our expertise covers Healthcare Support and Property & Facility Solutions within our Asset Management segment, and Infrastructure Services, along with Asset Consultancy within Infrastructure Solutions.

We offer our clients a full suite of services throughout their asset life cycle, which includes consultancy, procurement and construction planning, operations and maintenance, as well as optimisation, rehabilitation and upgrades.

UEM Edgenta is currently present in Malaysia, Singapore, Indonesia, Taiwan, India and the United Arab Emirates.

About The Team

Want to be part of a team that is serving over 300 hospitals across Malaysia, Singapore, Taiwan and India, Edgenta Healthcare Support is an internationally certified market leader in non-clinical healthcare support services? In Malaysia, we serve more than 60 public and private hospitals, as well as various healthcare institutions.Seniority level
  • Seniority level Mid-Senior level
Employment type
  • Employment type Full-time
Job function
  • Job function Health Care Provider
  • Industries Civil Engineering

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