Medical Claims Analytics & Compliance Specialist

Zurich 56 Company Ltd; Kuala Lumpur; On-site; MYR 67,000 - 100,000; Full time

Job summary

Responsibilities

• Conduct medical claims analysis to ensure compliance with regulations, coding rules and internal guidelines.
• Analyse claims data to identify leakage, compliance issues and operational risks.
• Identify and report suspected fraud or suspicious billing to senior team members.
• Perform audits and reviews of claims files to check accuracy and adherence to standards.
• Prepare clear audit reports to help managers understand issues and remediation steps.
• Ensure timely communication of key findings to stakeholders.
• Lead regulatory, management and TPA reporting for medical claims and ensure timely submissions.

Job description