Medical Director

9 hours ago

Kuala Lumpur, Kuala Lumpur, Malaysia Agensi Perkejaan Hunters Search Full time 120,000 - 200,000 per year

Job Responsibilities

1. Medical/Regulatory Oversight (Claims Management, Medical Auditing & FWA Identification)

  • Serve as Clinical Governance Officer (CGO) for all IHP clinics
  • Lead audit preparation and execution to ensure regulatory compliance
  • Act as the ordering doctor for laboratory and imaging tests, including prompt responses to critical results
  • Address general medical regulations queries from internal and external stakeholders
  • Lead initiatives to manage and reduce the cost of medical claims through clinical review, provider negotiation, and strategic interventions.
  • Conduct and oversee claims audits, identifying patterns of overutilization or fraud, waste, and abuse (FWA).
  • Monitor provider performance and billing behavior to identify and mitigate fraud, waste, and abuse (FWA); initiate corrective actions where necessary.
  • Develop internal cost containment SOPs and workflows in collaboration with operational teams to streamline claims processing and medical adjudication.
  • Act as the primary client-facing representative for all matters related to medical cost containment.
  • Prepare regular reports and presentations for leadership and clients, highlighting key cost drivers, trends, and opportunities for optimization.

2. Clinical Support

  • Review Patient Information Leaflets (PIL)
  • Perform regular medication reviews and sign off for VIP, ensuring safe and effective treatment plans

3. Claims, LOG and Pre-Authorization

  • Act as the final medical escalation point for claims, LOG, and pre-authorization within IHP
  • Develop and refine general guidelines and definitions for medical reimbursable claims

  • Provide strategic support to the Claims and LOG teams in developing and enhancing STP workflows and overall process improvements

  • Business Development Support

  • Participate in presentations and stakeholder engagement as a clinical representative

  • Collaborate on workflow reviews to align clinical operations with BD initiatives
  • Contribute to the ongoing refinement of IHP's data analytics, offering client insights and actionable strategies.
  • Provide KIV support for on-site rollout of services
  • Participation in initiative-based projects as required, including clinical input and representation in BD-related presentations and discussions.

5. Medical Services Program

  • Involvement in design, execution, and evaluation of new medical programs or processes, such as Chronic Disease Program and Letter of Pre-Authorization (LPA) Program.
  • Support for program rollout and ensuring medical compliance with local regulations.

Job Requirements:

  • Medical Degree from a recognized university (MD or MBBS preferred)
  • Minimum 5 years of relevant experience in TPA or insurance company
  • Willingness to support after-office-hours remotely
  • Willing to travel to Singapore at least once a month.

Remuneration:

MYR 12,000 - MYR 20,000

Working Location:

Kuala Lumpur or Penang (either or)

Consultant in-charge:

Kah Wai | | WhatsApp text only)

Job Type: Full-time

Pay: RM12, RM20,000.00 per month

Benefits:

  • Health insurance
  • Maternity leave
  • Opportunities for promotion
  • Parental leave
  • Professional development

Work Location: In person

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