PBTB | Assistant Manager, Fraud Waste and Abuse Management
On-siteKuala Lumpur, Kuala Lumpur, Malaysia
Kuala Lumpur, Kuala Lumpur, MalaysiaOn-siteFull TimeEnterprise
Full TimeEnterprise
Job Summary
Assess complex medical cases daily, manage referrals, and detect potential fraud, waste, and abuse while driving cost containment initiatives. Review and update Claims and Underwriting Guidelines to ensure industry standards are met, assess new technologies, and provide medical training to Operations. Conduct audits to evaluate technical capabilities and quality, supporting managers in claims reviews to ensure adherence to medical standards and Well versed in 13th Schedule, PHFSA, and MOH guidelines. Provide medical input to Product development and health awareness initiatives as required.
Required Qualifications
- Well versed in 13th Schedule, PHFSA, and MOH guidelines
- Responsible to identify claims leakages and prevent fraud, waste & abuse
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