Medical Director (KL / Penang)

Medical / Regulatory Oversight

• Serve as Clinical Governance Officer (CGO) for all IHP clinics
• Lead audit preparation and execution to ensure regulatory compliance
• Act as the ordering doctor for laboratory and imaging tests, including prompt responses to critical results
• Address general medical regulations queries from internal and external stakeholders
• Lead initiatives to manage and reduce the cost of medical claims through clinical review, provider negotiation, and strategic interventions.
• Conduct and oversee claims audits, identifying patterns of overutilization or fraud, waste, and abuse (FWA).
• Monitor provider performance and billing behavior to identify and mitigate fraud, waste, and abuse (FWA); initiate corrective actions where necessary.
• Develop internal cost containment SOPs and workflows in collaboration with operational teams to streamline claims processing and medical adjudication.
• Act as the primary client-facing representative for all matters related to medical cost containment.
• Prepare regular reports and presentations for leadership and clients, highlighting key cost drivers, trends, and opportunities for optimization.

Clinical Support

Claims, LOG and Pre-Authorization

Business Development Support

(Apply now at #J-18808-Ljbffr