Medical Advisory, Case and Fraud Management, Analyst

Job title: Medical Advisory, Case and Fraud Management, Analyst

Company: AIA


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.About the RoleResponsible 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.ResponsibilityTo pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company’s requirements and guidelinesTo lead the team and manage rostering / OT and FTE count needed for AGL and ADRTo ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assignedTo achieve team target Savings benchmarkTo 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 ADRTo mentor/coach and guide the TLs and assessors in robust decision makingTo ensure all guides and Cost savings initiatives are followed closely by Team leader and assessorsTo participate in outlining Medical training /roll downs according to the needs of the staffsTo participate in analysis and audits that are pertinent to cost savings across various units in AIATo participate in process improvement initiatives pertaining to system enhancement and refining process flow for the teamTo collaborate with various units in AIA in ensuring cost savings and CAR is achieved.To participate in workshops/seminars and discussion in cost saving initiatives/Fraud, waste and abuse mattersTo lead the Fraud, Waste and Abuse initiatives in conducting analysisTo performs other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirementsMinimum Job RequirementsEducation: Bachelor’s Degree in Administrative Studies, Biomedical / Technical Science, NursingYears of Experience: Minimum 3 years of relevant experienceTechnical Skills: guarantee letter issuance, healthcare delivery systems, hospital management, billing systemIndustry: Health Insurance, Third-Party Administrator, HospitalsLanguage: English and Bahasa MalaysiaBuild 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.

Expected salary:

Location: Kuala Lumpur

Job date: Fri, 21 Mar 2025 08:09:08 GMT

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