Medical Claims Analyst (Kuala Lumpur, MY)

Zurich Insurance
Kuala Lumpur
Workplace: OnsiteFull timeFunction: Healthcare (Clinical, Medical, Wellness)Skills: ["Analytical thinking","Attention to detail","Stakeholder communication","Process improvement","Quality focus"]

Analyze and audit medical claims to ensure compliance with regulations, coding rules, and internal standards. Review claims data and processes to detect leakage, operational risks, and improvement opportunities, and escalate suspected fraud or suspicious billing. Prepare audit and file review reports, lead regulatory/management/TPA reporting with strong data quality, and support day-to-day medical claims operations, TPA performance monitoring, and continuous improvement initiatives.

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Zurich Insurance
Zurich Insurance
5 hours ago

Medical Claims Analyst (Kuala Lumpur, MY)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 5 hours agoStatus: Live

Job Summary

Analyze and audit medical claims to ensure compliance with regulations, coding rules, and internal standards. Review claims data and processes to detect leakage, operational risks, and improvement opportunities, and escalate suspected fraud or suspicious billing. Prepare audit and file review reports, lead regulatory/management/TPA reporting with strong data quality, and support day-to-day medical claims operations, TPA performance monitoring, and continuous improvement initiatives.
Location: Kuala Lumpur
Workplace: Onsite
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Mid level

Key Responsibilities

  • •Conduct medical claims analysis and deep-dive reviews to ensure compliance with regulations, coding rules, and internal guidelines.
  • •Analyze claims data and processes to identify leakage, compliance issues, operational risks, and improvement opportunities.
  • •Perform audits and reviews of claims files, processes, and documentation for accuracy, quality, and adherence to standards.
  • •Prepare clear file review and audit reports and ensure timely communication of key findings and issues to stakeholders.
  • •Lead and coordinate regulatory, management, and TPA reporting for medical claims, including data quality, accuracy, and timely submissions.

Key Requirements

Skills:Analytical thinkingAttention to detailStakeholder communicationProcess improvementQuality focus

Company Brief

Zurich Insurance
Zurich Insurance Group is a global insurance company offering a wide range of general insurance and life insurance products and services to individuals, small businesses and large corporations across multiple markets worldwide.
Industry: Insurance
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Zurich, Switzerland
Founded: 1872
Glassdoor
Glassdoor: 3.7
WebsiteLinkedIn