Bring your career aspirations to life with AIA!

To assist the HOD and be the co-lead for handling all medical fraud related investigations and ensuring that the organisation is managed at a high level of governance for all aspects relating to medical fraud investigations.

To be the second point of contact for all medical fraud related investigations matters for the company, handling of suspicious or fraudulent medical claims pertaining to AIA Malaysia’s business operations for all the following entities:

i. AIA Bhd
ii. AIA Public Takaful Bhd
iii. AIA Health Services
iv. AIA General

• Taking the lead for all medical fraud investigations.
• Handling major / priority medical fraud investigations cases with the HOD.
• Providing job guidance to the medical fraud claims team in relation to detection and prevention of fraudulent medical claims and corrective measures to be taken to reduce incidents.
• Conduct objective, fair, thorough, unbiased and timely investigations into allegations of medical fraud committed by clients against the Company.
• Review and research medical investigation evidence/documents to analyze the overall fact pattern of medical claims and data and provide the necessary recommendations for improvement.
• Prepare, coordinate and lead field assignments for medical fraud investigations to obtain relevant evidence and information
• Coordinate with the authorities to provide strategies and use law enforcement resources to ensure that appropriate action is taken against the medical fraud perpetrators.
• Lead the development of policies and procedures where necessary to prevent medical fraud activities and to recover any incurred losses. 
• Identify the weakness of current control processes and recommend enhancements. 
• Collaborate investigation with appropriate business partners and authorities. 
• Conduct, manage and assist investigations into financial crime and security breaches as requested. 
• Timely completion of fraud investigations supported by evidence and quality reporting.
• Keeping the Company’s exposure to intermediary medical fraud financial exposure at a minimum level.
• Identifying trends through investigation outcomes.
• Appear during court hearings to testify as witnesses and present evidence from the investigation to support the testimony.
• The training of fraud investigation personnel and other claims personnel to ensure knowledge sharing and upskilling of the teams across the business and entities.
• To provide timely and quality reporting to the relevant management committees (including the market conduct committee, risk committees etc.) and acting on feedback /follow-up actions arising from such meetings/committees.
• Timely regulatory and group reporting.

Job Requirements

• Education: At least a Bachelor's Degree from a reputable university.
• Work Experience: At least 8 years of working experience in legal related field or equivalent.
• Good communication and writing skills.
• Understanding the nature of business.
• Have a flair for active listening and evidence gathering.
• Must have sound knowledge of relevant Laws and Regulations.

Build a career with us as we help our customers and the community live healthier, longer, better lives.

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