Training, Case Management & Ops SOP Governance, Analyst job opportunity at AIA Group.

Home Jobs In Malaysia Tag: Case Management & Ops SOP Governance, Analyst Training, Case Management & Ops SOP Governance, Analyst position at AIA Group


DatePosted 30+ Days Ago bot
AIA Group Training, Case Management & Ops SOP Governance, Analyst
Experience: 5-years
Pattern: full-time
Country:
apply Apply Now
Salary:
Status:

Case Management & Ops SOP Governance, Analyst

Copy Link Report
degreeOND
loacation Kuala Lumpur, MY-AIA Malaysia, Malaysia
loacation Kuala Lumpur, ..........Malaysia

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 & Responsiblities: To conduct Amount Under clarification (AUC) and case management, regular audits, and handle critical issues to identify Fraud, Waste and Abuse To ensure claim ad judication is in accordance with reasonable and customary charges and to review trending of doctors / members / agents that may or may not be in the watch list. To analyse and assess significant underwriting and claim cases with the aim of preventing fraud. To provide the ability to outline and implement process improvement strategies and cost-saving measures within insurance operations. To coordinate activities of expert resources in relevant functions / departments in the effort to resolve the case and recommend operational improvements as appropriate To interpret the 13th Schedule, Ministry of Health (MOH) letters, and assessment of reasonable and customary charges and align with medical procedures and costs. To provide basic Medical Advisory for claims team members on disputed charges and appeal. To respond to inquiries of a technical or complex nature through case management. To conduct robust medical training aligned with technical aspects of claims processing. To 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: Education: Bachelor’s degree in health sciences, Life Sciences, Healthcare Management, Nursing or equivalent. A medical degree is advantageous but not mandatory. Experience: Minimum 5 years in health claims management, case management, or clinical advisory roles. Prior audit or quality assurance experience preferred. Certifications/Licenses: Any industry-related medical or healthcare certification (e.g., claims adjudication, healthcare audit, or insurance-specific certifications). Strong analytical and audit skills. Knowledge of insurance claims adjudication, MOH guidelines, and clinical coding. Excellent communication and stakeholder management. High proficiency in MS Office, claims platforms, and report automation tools 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.

Other Ai Matches

Medical Claims Assessor (Hong Kong Market) - Mandarin Speaking Applicants are expected to have a solid experience in handling Job related tasks
Medical Technologist Applicants are expected to have a solid experience in handling Job related tasks
Legal Counsel Applicants are expected to have a solid experience in handling Job related tasks
（高级）经理，契约管理 Applicants are expected to have a solid experience in handling Job related tasks
Business Audit, Consultant Applicants are expected to have a solid experience in handling Consultant related tasks
Syariah Actuary Applicants are expected to have a solid experience in handling Job related tasks
Investment Chief Compliance Officer & Chief Risk Officer Applicants are expected to have a solid experience in handling Job related tasks
Senior Manager, Business & Financial Reporting Applicants are expected to have a solid experience in handling Business & Financial Reporting related tasks
Equity, Principal Applicants are expected to have a solid experience in handling Principal related tasks
Policy Owner Service, Specialist Applicants are expected to have a solid experience in handling Specialist related tasks
Middleware Platform, Consultant Applicants are expected to have a solid experience in handling Consultant related tasks
Customer Centres, Analyst (Virtual Branch) Applicants are expected to have a solid experience in handling Analyst (Virtual Branch) related tasks
Senior Manager, Business Development & Fund Advisory Applicants are expected to have a solid experience in handling Business Development & Fund Advisory related tasks
Corporate Sales Executive Applicants are expected to have a solid experience in handling Job related tasks
2026 AIA Group Office Summer Internship Program – Group Risk & Compliance Applicants are expected to have a solid experience in handling Job related tasks
Lead Analyst, Digital Distribution Solution Applicants are expected to have a solid experience in handling Digital Distribution Solution related tasks
Senior Analyst, Information Security Applicants are expected to have a solid experience in handling Information Security related tasks
Digital Experience, Principal Applicants are expected to have a solid experience in handling Principal related tasks
Operations Data Governance & Data Strategy, Senior Analyst Applicants are expected to have a solid experience in handling Senior Analyst related tasks
Bancassurance Sales, Analyst Applicants are expected to have a solid experience in handling Analyst related tasks
Actuarial - IFRS 17 Senior Manager Applicants are expected to have a solid experience in handling Job related tasks
Clinic Nurse Applicants are expected to have a solid experience in handling Job related tasks
Executive - Call Centre Applicants are expected to have a solid experience in handling Job related tasks