PBTB | Assistant Manager, Fraud Waste and Abuse Management
Core
Provide medical input, detect fraud/waste/abuse, and review guidelines to improve healthcare delivery and quality within the takaful sector.
Role type
Assistant Manager, Fraud Waste and Abuse Management
Builds
Medical support processes, updated claims/underwriting guidelines, and cost containment initiatives
Domain
Insurance (Takaful) / Healthcare Fraud Detection
Required skills
Medical expertise, fraud detection, guideline development, audit execution, cost containment, knowledge of PHFSA and MOH guidelines
Preferred skills
Experience with new technologies and procedures, training delivery
Technologies
None stated
Responsibilities
Assist assessors in managing complex medical cases and handling referrals; Review and update Claims and Underwriting Guidelines; Conduct audits to assess operational quality and adherence to medical standards; Identify claims leakages and prevent fraud, waste, and abuse; Provide medical training to operations teams.
Seniority
Manager, hands-on IC
