Associate, Medical, Fraud and Knowledge Management Associate, Medical, Fraud and Knowledge Management …

in Kuala Lumpur, Malaysia
Permanent, Full time
Be the first to apply
in Kuala Lumpur, Malaysia
Permanent, Full time
Be the first to apply
Associate, Medical, Fraud and Knowledge Management
Bring your career aspirations to life with AIA!
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.

  • To pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company's requirements and guidelines
  • To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned
  • To achieve team target Savings benchmark
  • To performs other responsibilities and duties periodically assigned by supervisor in order 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.
  • To mentor/coach and guide the TLs and assessors in robust decision making.
  • To ensure all guides and Cost savings initiatives are followed closely by Team leader and assessors.
  • To participate in outlining Medical training /roll downs according to the needs of the staffs.
  • To participate in analysis and audits that are pertinent to cost savings across various units in AIA.

Minimum Job Requirements
  • Good knowledge of current healthcare delivery systems and hospital management and billing system would be an advantage
  • 2 - 3 years of working experience in the service industry, preferably in healthcare or insurance
  • Good communication and interpersonal skill
  • Basic computer skill
  • Able to work with minimum supervision
  • Able to work on shift
  • Good team player
  • Able to work under pressure

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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