Senior Process Executive - Claim Excellence - Cantonese

Cognizant; Kuala Lumpur; On-site; MYR 60,000 - 90,000; Full time

Job summary

Cognizant is seeking a Senior Process Executive to support Fraud, Waste & Abuse activities in medical claims processing. The role involves reviewing claims for indicators, conducting investigations, and preparing case summaries while maintaining strict compliance.

An accelerated 5.5-month training programme precedes full responsibilities. Ideal candidates have relevant claims experience and strong analytical skills, with Cantonese proficiency; capable of working independently in a fast-paced

Qualifications

• 1-2 years minimum in medical claims processing, preferably outpatient or inpatient claims.
• Senior Advisor: 3-5 years in medical claims processing with complex claims involvement.
• Solid understanding of healthcare claims adjudication and policy benefits.
• Strong written and verbal communication, stakeholder management, and accountability.

Responsibilities

• Review and analyse medical claims for Fraud, Waste & Abuse indicators.
• Investigate assigned FWA cases and document findings accurately.
• Validate claims and identify irregular patterns or billing anomalies.
• Collaborate with internal stakeholders to gather supporting information.
• Prepare case summaries, recommendations, and investigation outcomes timely.
• Ensure compliance with internal policies, procedures, and regulatory requirements.
• Meet productivity, quality, and turnaround time targets.
• Engage in continuous learning and capability enhancement in FWA.
• Support ad-hoc projects and operational improvement activities as assigned.

Skills

Claims knowledge

Analytical thinking

Attention to detail

Independent work

Communication skills

Cantonese proficiency

Job description

The Senior Process Executive will support Fraud, Waste & Abuse (FWA) activities through claims review, case analysis, and identification of potential irregularities within medical claims processing. The role requires strong claims knowledge, analytical thinking, attention to detail, and the ability to work independently in a fast-paced environment.

The successful candidate will undergo an accelerated training and capability-building programme of approximately 5.5 months before transitioning to full operational responsibilities.

Roles And Responsibilities

• Review and analyse medical claims for potential Fraud, Waste & Abuse indicators
• Perform investigations on assigned FWA cases and document findings accurately.
• Conduct claim validation and identify irregular claim patterns or billing anomalies.
• Collaborate with internal stakeholders to obtain supporting information and clarify case details.
• Prepare case summaries, recommendations, and investigation outcomes in a timely manner.
• Ensure compliance with internal policies, operational procedures, and regulatory requirements.
• Meet productivity, quality, and turnaround time targets.
• Participate in continuous learning and FWA capability enhancement initiatives.
• Support ad-hoc projects and operational improvement activities as assigned.

Experience

• Minimum -1-2 years of experience in medical claims processing, preferably in:
  • Outpatient (OP) Claims
  • Inpatient (IP) Claims
• Good understanding of healthcare claims adjudication and policy benefits.
• Strong analytical and problem-solving skills.
• High attention to detail and accuracy.
• Good written and verbal communication skills.
• Senior Advisor - Minimum 3–5 years of experience in medical claims processing, preferably involving:
  • Outpatient (OP) Claims
  • Inpatient (IP) Claims
• Complex claims assessment or claims investigation
• Experience in quality review, coaching, or subject matter expertise is an added advantage.
• Demonstrated ability to work independently and manage complex cases.
• Strong stakeholder management and communication skills
• Self-disciplined and highly accountable.
• Demonstrates dedication and commitment to learning.
• Strong investigative mindset and critical thinking skills.
• Ability to handle confidential information with integrity.
• Adaptable and able to work under minimal supervision.
• Team player with a positive attitude and continuous improvement mindset.

Language: Must be Proficient in Cantonese (Written & Verbal)

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.