Medical Claims Analyst

Zurich Services Malaysia Sdn. Bhd.; Subang Jaya; On-site; MYR 60,000 - 90,000; Full time

Job summary

Zurich Services Malaysia Sdn. Bhd. is seeking a Claims Analyst to conduct medical claims analysis and deep-dive reviews to ensure compliance with regulations, coding rules and internal guidelines.

The role involves analyzing claims data to identify leakage, compliance issues, and operational risks, and reporting suspected fraud or suspicious billing to senior team members. The successful candidate will also perform audits of claims files and documentation to check accuracy and quality,

Responsibilities

• Conduct medical claims analysis and deep-dive reviews to ensure compliance with regulations, coding rules and internal guidelines.
• Analyse claims data and processes to identify leakage, compliance issues, operational risks and improvement opportunities.
• Identify and report suspected fraud or suspicious billing, escalating to senior team members when necessary.
• Perform audits and reviews of claims files, processes and documentation to check accuracy, quality and…

Job description

Job Description _

• Conduct medical claims analysis and deep-dive reviews to ensure compliance with regulations, coding rules and internal guidelines.
• Analyse claims data and processes to identify leakage, compliance issues, operational risks and improvement opportunities.
• Identify and report suspected fraud or suspicious billing, escalating to senior team members when necessary.
• Perform audits and reviews of claims files, processes and documentation to check accuracy, quality an...