Executive / Senior Executive, Medical Auditor (Healthcare Compliance)

Protecthealth Corporation; Sepang; On-site; MYR 60,000 - 80,000; Full time

Job summary

A healthcare compliance organization is seeking an Executive/Senior Executive Medical Auditor to uphold the integrity of national healthcare programs in Malaysia. This role involves conducting audits, reviewing claims, and collaborating with providers to ensure quality and compliance. The ideal candidate will have a relevant degree and 2-5 years of experience in healthcare auditing or fraud detection. The position is a 1-year contract with potential renewal based on performance.

Benefits

Competitive remuneration and comprehensive benefits

Continuous learning and career growth

Work-life balance initiatives

Qualifications

• 2–5 years of experience in healthcare auditing or fraud detection.
• Strong knowledge of healthcare quality standards and clinical documentation.
• Ability to handle sensitive data discreetly and ethically.

Responsibilities

• Conduct structured audits on healthcare providers.
• Review medical claims and provider performance.
• Prepare and present detailed audit reports.
• Collaborate closely with internal teams to address issues.

Skills

Healthcare auditing

Claims management

Analytical skills

Communication skills

Education

Bachelor’s Degree in Medicine, Pharmacy, Nursing, Health Economics

Job description

Executive / Senior Executive, Medical Auditor (Healthcare Compliance)

Protecthealth Corporation – Sepang, Selangor

What we offer

• Competitive remuneration and a comprehensive benefits package
• Continuous learning, professional development, and career growth opportunities
• A supportive, collaborative, and mission-driven work environment
• Work-life balance initiatives, including flexible working arrangements

About the role

• As a Medical Auditor at ProtectHealth, you will play a vital role in upholding the integrity of Malaysia’s national healthcare programs. You will ensure that hospitals, clinics, and laboratories deliver quality, ethical, and compliant healthcare services while identifying and mitigating risks of fraud, waste, and abuse (FWA). Your contribution will directly support transparency, accountability, and better outcomes across the healthcare ecosystem.

What you’ll be doing

• Conduct structured audits on healthcare providers under national health programs such as PeKa B40, Skim Perubatan Madani (SPM), and HSOP, ensuring compliance with ProtectHealth’s standards, policies, and scheme guidelines.
• Review medical claims, treatment records, and provider performance to ensure alignment with clinical and operational standards.
• Detect potential non-compliance, unethical practices, or fraudulent activities, and recommend appropriate corrective and preventive measures.
• Prepare and present detailed audit reports and recommendations to management for decision‑making and improvement initiatives.
• Collaborate closely with internal teams and stakeholders to address non‑compliance issues and enhance provider performance.
• Contribute to the development and refinement of internal audit methodologies, tools, and best practices tailored for healthcare service evaluation.

What we’re looking for

• Bachelor’s Degree in Medicine, Pharmacy, Nursing, Health Economics, or a related field.
• 2–5 years of experience in healthcare auditing, claims management, clinical governance, or fraud detection within the healthcare or insurance sector.
• Strong knowledge of healthcare quality standards, clinical documentation, and operational frameworks.
• Analytical and detail-oriented, with the ability to handle sensitive data discreetly and ethically.
• Excellent written and verbal communication skills, with proven ability to engage stakeholders professionally.
• Willingness to travel frequently for audit and site assessment activities.

This is a 1-year contract position, renewable based on performance, conduct, and discipline.

Only shortlisted candidates will be invited for an interview.

Only Malaysian citizens will be considered for this role.