Medical Adjudication, Specialist

AIA

  • Singapore
  • Permanent
  • Full-time
  • 1 month ago
At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.Sound like you? Then read on.About the Role1. Perform accurate adjudication of complex and high-value medical claims
2. Identify fraudulent or abusive patterns, ensuring compliance with internal policies, regulatory standards.Job Responsibilities:
  • Review and adjudicate complex medical claims, especially outliers, to identify potential fraud, waste, or abuse (FWA)
  • Collaborate with medical providers, third party administrators, and internal stakeholders to investigate questionable claims and perform fact-finding when discrepancies arise.
  • Negotiate with service providers on unreasonable charges and challenge inflated or non-medically necessary items.
  • Apply evidence-based clinical knowledge to support fair, consistent decisions, ensuring adherence to company policy and regulatory frameworks.
  • Lead discussion with agents, administration teams, and policyholders to explain adjudication outcome, ensuring clarity.
  • Contribute insights to the development of automated adjudication tools, AI driven fraud detection, and continuous process improvements.
  • Meet SLA timelines for claims adjudication, reporting, and closure.
  • Provide expert recommendations on emerging FWA trends and recommend preventive strategies.
Job Requirements:
  • Educational background - Registered Nurse or Medical officer/doctors
  • Minimum 3-5 years Clinical/Surgical experience in Singapore
  • At least 1 year Insurance-related or health insurance adjudication experience is preferred, but not necessary
  • Health Insurance-related certification is an advantage
  • Strong clinical reasoning and analytical thinking
  • Communication and negotiation skills, especially when dealing with policyholder, agents and healthcare providers
  • Computer literacy – Microsoft Word and Excel
  • Proficiency in written and spoken English
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

AIA