PBTB | Assistant Manager, Fraud Waste and Abuse Management
Core
Provide medical input and expertise to support fraud, waste, and abuse management, including case assessment, guideline development, and quality audits.
Role type
Assistant Manager, Fraud Waste and Abuse Management (Medical)
Builds
Claims and Underwriting Guidelines, medical training programs, cost containment initiatives
Domain
Insurance (Takaful) / Healthcare Fraud Detection
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Medical case assessment, guideline review and update, audit execution, fraud detection, cost containment, knowledge of PHFSA and MOH guidelines, training delivery
Preferred skills
Experience in takaful sector, familiarity with new technologies and procedures
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, drive cost containment initiatives and identify claims leakages, provide medical training to operations teams
Seniority
Manager, hands-on IC