Quality Reviewer (Medical Pre-Underwriting - Health Insurance)

The Institute of Internal Auditors; Kuala Lumpur; On-site; MYR 100,000 - 150,000; Full time

Job summary

An opportunity for a Quality Reviewer in Medical Pre-Underwriting for Health Insurance at a renowned organization. The role involves conducting audits on underwriting decisions, ensuring compliance with regulatory standards, and providing feedback for process improvement. The ideal candidate will have a strong background in health insurance with a relevant degree and proficiency in Cantonese, Mandarin, and English.

Qualifications

• Bachelor's degree in Life Sciences, Nursing, Healthcare Administration, or related field.
• 3-5 years of experience in health insurance underwriting or quality assurance.
• Strong knowledge of Hong Kong's health insurance regulatory framework.
• Fluency in Cantonese, Mandarin, and English (speak, read, and write).

Responsibilities

• Conduct quality audits of underwriting decisions made by processors.
• Ensure adherence to underwriting guidelines and regulatory standards.
• Identify trends in processing errors and recommend corrective actions.
• Collaborate with training teams to address knowledge gaps.
• Review escalated cases for accuracy and completeness.
• Maintain audit logs and prepare quality reports for management.
• Ensure compliance with IA regulations and internal audit protocols.
• Assist in updating standard operating procedures based on audit findings.
• Support continuous improvement initiatives in underwriting workflows.
• Provide feedback to processors to enhance accuracy and efficiency.
• Participate in system testing for underwriting rule updates.
• Ensure confidentiality and integrity of medical data during reviews.

Skills

Quality Auditing

Regulatory Standards Compliance

Feedback Provision

Education

Bachelor's degree in Life Sciences, Nursing, Healthcare Administration, or related field

Job description

Job Title: Quality Reviewer (Medical Pre-Underwriting - Health Insurance)

Job Location: Malaysia

Job Responsibilities and Expectations

• Conduct quality audits of underwriting decisions made by processors.
• Ensure adherence to underwriting guidelines and regulatory standards.
• Identify trends in processing errors and recommend corrective actions.
• Collaborate with training teams to address knowledge gaps.
• Review escalated cases for accuracy and completeness.
• Maintain audit logs and prepare quality reports for management.
• Ensure compliance with IA regulations and internal audit protocols.
• Assist in updating standard operating procedures based on audit findings.
• Support continuous improvement initiatives in underwriting workflows.
• Provide feedback to processors to enhance accuracy and efficiency.
• Participate in system testing for underwriting rule updates.
• Ensure confidentiality and integrity of medical data during reviews.

Academic and Additional Qualifications Needed

• Bachelor's degree in Life Sciences, Nursing, Healthcare Administration, or related field.
• 3-5 years of experience in health insurance underwriting or quality assurance.
• Strong knowledge of Hong Kong's health insurance regulatory framework.
• Fluency in Cantonese, Mandarin, and English (speak, read, and write).

About Cognizant :

Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Together, we're improving everyday life. See how at www.cognizant.com or @cognizant .