Lead Specialist - Claims (Fraud, Waste & Abuse)
On-siteCyberjaya, Selangor, Malaysia
Cyberjaya, Selangor, MalaysiaOn-siteFull TimeSenior LevelBachelors DegreeEnterprise
Full TimeSenior LevelBachelors DegreeEnterprise
Job Summary
Lead Specialist - Claims (Fraud, Waste & Abuse): Assess outpatient and inpatient hospitalization claims, conduct end-to-end FWA investigations, analyze and interpret claims data to identify fraudulent activity, perform interviews when required, verify supporting documentation, and prepare clear investigation findings and reports. Utilize analytics and AI-enabled insights to support decision-making, contribute to fraud trend monitoring, and support claims processing during peak periods while maintaining quality and control standards. Office location: Cyberjaya/Putrajaya, Malaysia.
Required Qualifications
- Minimum 6 years of experience assessing inpatient and outpatient medical reimbursement claims, with a solid understanding of billing practices.
- Minimum 3 years of experience medical claims investigation.
- Bachelor's degree in Biomedical Science, Biotechnology, Biology, Health Science or related fields.
- Demonstrated ability to analyze claims data and detect abnormal billing patterns.
- Strong analytical and problem-solving skills, with high attention to detail and accuracy when reviewing claims and supporting documentation.
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