11 Needs Coordinator jobs in Malaysia

Join to apply for the Customer Care Coordinator role at OnTheList

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Join to apply for the Customer Care Coordinator role at OnTheList

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Founded in Hong Kong in 2016 by the French couple Delphine Lefay and Diego Dultzin Lacoste, OnTheList is Asia’s first members-only flash sales concept. OnTheList works directly with retail brands and official distributors, turning old inventory into opportunity by providing a sustainable way for brands to sell past-season items that would have otherwise ended up in landfills, while providing the best deals and steep discounts to our OnTheList members.

Since launching in Hong Kong in 2016, OnTheList has hosted over 5,200 flash sales and has built a community of over 1.3 million members across all regions. We’ve since expanded to Singapore, Australia, Malaysia, Korea, Shanghai, Beijing, Thailand, and Dubai.

Sustainability is rooted in who we are and motivates us to continue our mission. To date, we have saved over 8.2 million items from ending up in landfills. Forming OnTheLove, our CSR initiative, has allowed us to deepen our commitment to minimizing our carbon footprint while working with local organizations and hosting regular charity sales.

At OnTheList, our values guide everything we do: Family Spirit is driven by humility, fostering genuine connections with our community. Panache reflects our passion for delivering exceptional experiences, while sustainability is rooted in our commitment to creating a positive impact on the world around us. Excellence is driven by the cooperation of our teams.

Customer Care Coordinator

The role is supporting the team to maintain a high level of customer satisfaction by resolving customer related issues; and enhance member loyalty by establishing rapport with the members across APAC market. Act as the first contact point of OnTheList retail and e-commerce market, to consistently deliver an exceptional customer experience to our global customers during their shopping journey.

WHAT WE WILL TRUST YOU WITH

• Handle and follow up daily customer enquiries for both Instore & Online platforms in a timely and professional manner (including but not limited to product and pricing, order status, billing checking, delivery, complaint, or any post-sales issues through email)
• Offer exceptional & courteous services to our members and provide support to our regional markets
• Manage customer complaints effectively and provide the best appropriate solutions to meet both customers’ needs and business objective
• Liaise with all brand partners for after sales support
• Maintain good communication with the external warehouse & delivery team to ensure orders are packed well and delivered on time
• Work closely with E-commerce Team for presale/aftersales issue and provide feedback for better customer experience
• Liaise with internal teams for online return & exchange procedures
• Analyse and evaluate customer feedback and provide suggestions to optimise customer experience for both online and offline platform in weekly meetings
• Support ad-hoc projects as assigned

WHAT IT TAKES

• Degree holder with relevant discipline
• Customer-oriented mindset with good telephone and written communication manner
• Highly-proficient in spoken and written English and Chinese (Cantonese & Mandarin)
• Well-organized, detail-minded, self-motivated, high responsibility
• Excellent MS Excel, Word and PowerPoint skills essential

• Seniority level Entry level

• Employment type Contract

• Job function Customer Service
• Industries Retail Apparel and Fashion

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WP. Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 days ago

KL Eco City, Federal Territory of Kuala Lumpur, Malaysia 6 days ago

Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 3 weeks ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 5 days ago

Federal Territory of Kuala Lumpur, Malaysia 3 weeks ago

Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 2 weeks ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 1 week ago

Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia 3 months ago

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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

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COMPANY DESCRIPTION

MINDS has been caring for Persons with Intellectual Disabilities (PWIDs) and their families since 1962.

Grounded in the belief that all PWIDs have innate abilities and talents, MINDS is committed to empowering them and enhancing their quality of life, while advocating for greater inclusivity for PWIDs as a nation.

MINDS is today one of the largest charities in Singapore employing more than 850 staff. With the key focus to expand community-based services, improving the employability of PWIDS, strengthening education, and engendering inclusive community living, MINDS offers a holistic range of services and programmes across the PWIDs' lifespan.

These include schools, employment and training development centres, home-based care services and community-based services to cater to the physical, psychological, environmental and social needs of PWIDs. For more information, please visit

RESPONSIBILITIES

The Operations Support Staff assists to ensure smooth running in the day-to-day operations of the adult services centre. This includes, but is not limited to, direct care for clients, facility management and maintenance, operational support, support for centre activities and events, and simple administrative tasks.

Client Care

• Assist in client movement, personal hygiene and toileting

• Clean soiled areas and equipment

• Assist centre staff on client support as needed.

Centre Events/Activities

• Put up/remove decorations for special festivities and events

• Packing and distribution of items for programmes and events

• Arrange refreshments for meetings and functions

Facility Management

• Attend to simple faults and repairs

• Assist in facility inspections and reporting, including safety checks, faults and defects

• Assist the Environment Control Coordinator (ECC) in cleaning and disinfection of surfaces in contact with bodily discharge

• Assist ECC in checking for potential vector breeding areas

Administrative Support

• Sorting, packing and shredding of documents

• Simple filing of documents

• Simple data entry

• Completed Primary Education
• At least 3 years of related experience
• (Any other specific requirements e.g. experience with methodology or previous projects done, etc.)

At OKX, we believe that the future will be reshaped by crypto, and ultimately contribute to every individual's freedom.

OKX is a leading crypto exchange, and the developer of OKX Wallet, giving millions access to crypto trading and decentralized crypto applications (dApps). OKX is also a trusted brand by hundreds of large institutions seeking access to crypto markets. We are safe and reliable, backed by our Proof of Reserves.

Across our multiple offices globally, we are united by our core principles: We Before Me , Do the Right Thing , and Get Things Done . These shared values drive our culture, shape our processes, and foster a friendly, rewarding, and diverse environment for every OK-er.

OKX is part of OKG, a group that brings the value of Blockchain to users around the world, through our leading products OKX, OKX Wallet, OKLink and more.

1. Community Building and Engagement:

• Professional in Telegram and Discord bots development, integration, and maintenance.
• Organize and host community events & AMAs.
• Foster a positive and inclusive community culture by moderating discussions and addressing user concerns.
• Encourage user interaction and participation through contests, giveaways, and other engagement initiatives.

2. Content Creation and Curation:

• Develop and publish high-quality content, such as blog posts, articles, and social media updates, related to cryptocurrency and blockchain technology and provide tutorials on OKX's products and services.
• Curate and share relevant content from other sources to keep the community informed and engaged.
• Respond to user comments, questions, and inquiries promptly and informally.

3. User Support and Onboarding:

• Provide excellent customer interaction to users through various channels (e.g. social media).
• Assist users with account creation, verification, general issues, and troubleshooting.
• Onboard new users and educate them about the platform's features and functionalities.

4. Community Campaigns and Promotion:

• Develop and implement marketing strategies to attract new users and retain existing ones.
• Collaborate with other departments (e.g., marketing, product, web3) to promote our products and services.
• Monitor and analyze community metrics to measure the effectiveness of community campaigns.

5. Community Partnerships:

• Collaborate with other crypto projects, influencers/KOLs, and communities to expand the platform reach and network.
• Foster partnerships to create mutually beneficial collaborations and cross-promotions.

6. Risk Management and Compliance:

• Ensure compliance with relevant regulations and industry standards.
• Monitor community activity for potential risks or issues and take appropriate action.

7. Data Analysis and Reporting:

• Track and analyze community metrics to measure performance and identify areas for improvement.
• Prepare regular reports on community engagement, growth, and key performance indicators.

• Strong understanding of cryptocurrency, blockchain technology, and the crypto industry.
• Excellent communication and interpersonal skills.
• Experience in community management and building online communities.
• Strong writing and content creation skills.
• Proficiency in social media platforms and tools.
• Ability to work independently and as part of a team.
• Passion for the crypto industry and a desire to contribute to its growth.

• Willing to work according to the given schedule, including rotational shifts (morning and noon) .
• Willing to work in Tun Razak Exchange, walking distance to MRT TRX.
• Competitive remuneration package (Base Salary + Shift Allowance + Yearly Bonus)
• Meal allowance up to RM 500/ month
• Unlimited transport allowance (T&C apply)
• Monthly team building
• RM 3,500 training & wellness benefits per annum
• Convenient workplace (5 minutes walk from MRT TRX)
• Insurance coverage for employees & dependants
• Excellent prospects for growth and promotion: We provide you with assistance, opportunities for skill development, mentoring, and training programmes to help you succeed
• Employee engagement, recognition and appreciation program
• Multinational working environment: Advance your career by interacting with individuals from various backgrounds, cultures, and nation

Information collected and processed as part of the recruitment process of any job application you choose to submit is subject to OKX 's Candidate Privacy Notice .

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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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