PBTB | Assistant Manager, Fraud Waste and Abuse Management

Prudential plc; Kuala Lumpur; On-site; MYR 120,000 - 180,000; Full time

Job summary

Prudential plc is seeking a dedicated medical management professional to support the company with medical input, policy guideline reviews, and quality assurance across the takaful sector.

You will collaborate with multiple departments to ensure medical standards are upheld, train operations, and help detect and prevent fraud, waste, and abuse.

Responsibilities

• Assist assessors in managing complex cases on daily basis, including handling medical referrals and detecting potential
• Provide medical input & expertise to other departments such as Product development, health awareness initiatives as required
• To review & update the Claims and Underwriting Guidelines to ensure current industry standard are met
• To assess and review new technologies and procedures
• Provide medical training to the Operations to ensure knowledge is up to date
• Conduct audit to assess the technical capabilities & quality of the Operations
• Support the managers in the claims review to ensure adherence to medical standards
• Well versed in 13th Schedule, PHFSA, and MOH guidelines
• Drive cost containment initiatives
• Responsible to identify claims leakages and prevent fraud, waste & abuse

Job description

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Together with Medical Management team, to serve as a comprehensive unit to provide medical input in all areas in the company.

Join a dedicated team focused on improving the healthcare delivery and quality within the takaful sector. Be part of a dynamic environment where your expertise can make a real impact.

Key responsibilities:

a) Medical support across the company

• Assist assessors in managing complex cases on daily basis, including handling medical referrals and detecting potential
• Provide medical input & expertise to other departments such Product development, health awareness initiatives as required

b) Establish and review guidelines

• To review & update the Claims and Underwriting Guidelines to ensure current industry standard are met
• To assess and review new technologies and procedures.
• Provide medical training to the Operations to ensure knowledge is up to date

c) Medical Quality Review

• Conduct audit to assess the technical capabilities & quality of the Operations
• Support the managers in the claims review to ensure adherence to medical standards
• Well versed in 13th Schedule, PHFSA, and MOH guidelines
• Drive cost containment initiatives
• Responsible to identify claims leakages and prevent fraud, waste & abuse

Together with Fraud, Waste & Abuse Management team, to serve asa comprehensive unit to support medical business in all areas in the company.

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.