Jobs Companies AIA Lead Specialist - Claims (Fraud, Waste & Abuse)

Sobre esta vaga de Lead Specialist - Claims (Fraud, Waste & Abuse) na AIA

AIA · Presencial · Cyberjaya, MY-AIA Shared Services Malaysia

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About the Role

Assess outpatient and inpatient hospitalization claims from Group policyholders as per stipulated benchmarks and requirements.

  • Perform end‑to‑end FWA investigations in accordance with established investigation frameworks, governance standards and confidentiality requirements

  • Identify, analyze and assess suspicious or potentially fraudulent claims by reviewing claims documentation and interpreting transactional, behavioral and historical claims data

  • Apply risk‑based investigation techniques to prioritize cases, balancing investigation depth, timeliness and potential financial or reputational impact

  • Conduct claimant, provider or third‑party interviews where required, ensuring adherence to investigation protocols, professionalism and non‑tipping‑off principles

  • Verify claim documentation and supporting records, identifying indicators of forged, altered or inconsistent information using structured review methods and available digital validation tools

  • Prepare clear, accurate and well‑documented investigation findings, case notes and reports for review, escalation or submission to the SG Fraud team

  • Utilize claims analytics, rule‑based detection outputs and AI‑enabled insights (where available) to support case assessment, pattern identification and investigation decision‑making

  • Contribute to fraud trend monitoring by highlighting emerging fraud typologies, abnormal behaviors or systemic vulnerabilities observed during investigations

  • Support claims processing activities during peak periods, surge volumes or contingency situations, while maintaining vigilance on fraud risks and adhering to quality and control standards

Requirements

  • Minimum 6 years of experience assessing inpatient and outpatient medical reimbursement claims, with a solid understanding of billing practices.

  • Minimum 3 years of experience medical claims investigation. Experience on Fraud, Waste and Abuse (FWA) will be an added advantage.

  • Bachelor's degree in Biomedical Science, Biotechnology, Biology, Health Science or related fields.

  • Demonstrated ability to analyze claims data and detect abnormal billing patterns.

  • Strong analytical and problem‑solving skills, with high attention to detail and accuracy when reviewing claims and supporting documentation.

  • Office Location: We will be moving to IOI Tower, Putrajaya in Quarter 3 of 2026.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

Pronto para se candidatar à AIA?
Candidatar-se à AIA

Sobre a AIA

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone. It's about finding new ways to not only better people's lives, but to better the communities and environments we live in. As the largest listed company on the Hong Kong Stock Exchange, we’ve been proudly making a difference for people and communities across Asia for over a century. And we build on this every day with our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030. If you work at AIA, you play an important part in this movement. Which is why we give you every opportunity to learn, grow and shape your career - your way. Inspiring and supporting you t

Ver todas as vagas na AIA →

Vagas semelhantes

AIA
CS Sales Conduct Assurance, Agency Distribution, Principal
AIA
⚡ Candidate-se cedo Hong Kong, HK-AIA Hong Kong &... Presencial
● Nova 👁 Vista ✓ Candidatada há 9h
AIA
Financial Planning & Analysis, Principal
AIA
⚡ Candidate-se cedo Hong Kong, HK-AIA Hong Kong &... Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
高级工程师,数据仓库
AIA
⚡ Candidate-se cedo Shanghai, CN-AIA China Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
Analyst, Enterprise Platform Transformation
AIA
⚡ Candidate-se cedo Kuala Lumpur, AIA Digital+ Mal... Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
Director of Football Initiatives & Sponsorships
AIA
⚡ Candidate-se cedo Hong Kong, HK-AIA Group Office Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
Digital Experience, Senior Principal
AIA
⚡ Candidate-se cedo Hong Kong, HK-AIA Hong Kong &... Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
Senior Manager, International Growth
AIA
⚡ Candidate-se cedo Melbourne, AU-AIA Australia Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
Senior Analyst, HRIT
AIA
⚡ Candidate-se cedo Kuala Lumpur, AIA Digital+ Mal... Presencial
● Nova 👁 Vista ✓ Candidatada há 2d
AIA
Talent Acquisition Manager (Tied Distribution)
AIA
⚡ Candidate-se cedo Singapore, SG-AIA Singapore Presencial
● Nova 👁 Vista ✓ Candidatada há 2d

Cadastre-se para receber sugestões sob medida com base nas vagas que você abre e nas buscas que você salva.

Mais vagas na AIA

Ver todas as vagas na AIA →

Candidatar-se agora
🤖

Opa — calma aí

A JobsRadar foi feita para pessoas de verdade passando por um momento difícil na busca por emprego — não para requisições automatizadas. Você está clicando rápido demais e agora está temporariamente bloqueado.

Volte mais tarde. Se você está mesmo procurando emprego, estamos com você — apenas aja como um ser humano.

Catch your next role the second it’s posted.

Create a free account and we’ll watch the boards for you — the instant a job matches your search, it lands in your inbox or Telegram. No digging, no refreshing.

Create free account

Free forever · takes 30 seconds · already have one?

Ganhe vantagem na sua busca por emprego.

Entre no nosso canal do Telegram para o que ajuda você a conseguir a vaga — referências salariais, o pulso semanal do mercado e avisos de novos recursos. Sem spam, só sinal.

Entre no canal — é grátis