Manager, Medical Advisory, Health Technical Excellence, and Fraud, Waste & Abuse Management
Prudential · Kuala Lumpur (Takaful)
Full-timeonsiteleadHealthcareHealthcare
รายละเอียดงาน / Description
Based in Malaysia, this role leads initiatives in medical advisory, audit execution, and the containment of health claim leakages. The chosen candidate will spearhead fraud, waste, and abuse (FWA) detection frameworks while applying advanced analytical tools to improve claims performance. You will also formulate compliance policies, conduct team training, and collaborate closely with clinical stakeholders to enhance technical excellence.
หน้าที่ความรับผิดชอบ / Responsibilities
- Deliver expert medical advisory, conduct audits, and control health claim leakages to optimize loss ratios
- Design, revise, and govern corporate policies dedicated to fraud, waste, and abuse management
- Supervise the implementation of AI and machine learning tools to detect anomalies and fraudulent claims
- Organize training programs and assessments to elevate internal awareness of FWA standards
- Execute periodic audits to guarantee policy compliance and enforce corrective action plans
- Deliver analytical reports and strategic insights to leadership and external healthcare stakeholders
คุณสมบัติ / Qualifications
- Tertiary qualification with a recognized medical degree required
- Between 3 and 5 years of relevant professional experience in healthcare claims or FWA management
- Strong background in medical auditing, cost containment, and claim leakage control
- Familiarity with FWA analytical software and applications of machine learning in fraud prevention
- Deep knowledge of clinical regulations, compliance mandates, and physician fee schedules
- Proven leadership ability and clear stakeholder communication capabilities
ทักษะที่ต้องการ / Required skills
- Medical Advisory
- Fraud Waste and Abuse (FWA)
- Health Claims
- Clinical Auditing
- Machine Learning
- Cost Containment
- Compliance
- Data Analysis
- Stakeholder Management