Training, Case Management & Ops SOP Governance, Analyst

Training, Case Management & Ops SOP Governance, Analyst

AIA Malaysia Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia

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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

Responsible for determining operational excellence and customer satisfaction by empowering assessors through continuous training, reducing operational costs, ensuring consistent in validity and authorizing settlement of medical health. Responsible for handling complex policy cases which require special investigative skills or significant involvement and collaboration from different stakeholders to follow through together with MOH directives while fostering a culture of compliance, efficiency, and integrity.

Roles & Responsibilities

• Conduct Amount Under clarification (AUC) and case management, regular audits, and handle critical issues to identify Fraud, Waste and Abuse.
• Ensure claim adjudication is in accordance with reasonable and customary charges and review trending of doctors / members / agents that may or may not be in the watch list.
• Analyze and assess significant underwriting and claim cases with the aim of preventing fraud.
• Provide the ability to outline and implement process improvement strategies and cost‑saving measures within insurance operations.
• Coordinate activities of expert resources in relevant functions / departments to resolve the case and recommend operational improvements as appropriate.
• Interpret the 13th Schedule, Ministry of Health (MOH) letters, and assessment of reasonable and customary charges and align with medical procedures and costs.
• Provide basic Medical Advisory for claims team members on disputed charges and appeal.
• Respond to inquiries of a technical or complex nature through case management.
• Conduct robust medical training aligned with technical aspects of claims processing.
• Mentor / coach and guide the TLs and assessors in robust decision making.
• May work with third parties and government authorities to support external investigation and prosecution of fraudulent cases.

Minimum Job Requirements

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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