Fatin Nabiha Binti Mohd Sarbani
Medical Claims Assessor
47630 Subang Jaya
Summary
Experienced Claims Assessor with over 9 years in insurance and healthcare, specializing in medical claims processing, policy interpretation, and fraud detection. Proven ability to assess claims accurately and efficiently while ensuring full compliance with regulatory guidelines. Brings a strong understanding of medical terminology, policy benefits, and end-to-end claims assessment.
Overview
11
11
years of professional experience
Work History
Return/Refund (RR) Fraud Lead
Shopee
12.2023 - 04.2025
- Reduced false positive rates by 10% and fraud-related losses to under 5% of total compensation by pioneering a tiered suspension system, leveraging predictive analytics, and implementing real-time monitoring tools.
- Enhanced fraud detection scalability and efficiency by automating deep profile checks, standardizing watchlist logic across markets, and delivering insights that cut collusion cases by 20%.
Claims and Customer Service Lead
BIMA (Milvik MY)
10.2021 - 10.2023
- Elevated customer service performance by driving AHT to 80%, and Service Level >80% through real-time dashboards monitoring, agent coaching, and the successful rollout of an AI-powered WhatsApp chatbot that reduced response time by 40% and deflected 30% of inquiries.
- Optimized end-to-end claims operations by cutting processing time by 33% while ensuring 100% BNM compliance; reduced customer complaints by 25% through proactive journey mapping and process enhancements.
Medical Claims Executive/Assessor
AIA Health Services
09.2017 - 05.2021
- Processed initial and final guarantee letters according to respective individual policy benefits within TAT.
- Prevented ~4% fraudulent payouts annually through enhanced claims scrutiny and collaboration with 50+ healthcare providers.
- Achieved 98% accuracy rate in claims assessments while meeting 100% of monthly transaction targets.
Registered Nurse
University Malaya Medical Center (UMMC)
07.2014 - 09.2016
- Delivered critical care to pediatric clients with 100% adherence to medical protocols and regulatory standards.
- Collaborated effectively with cross-functional medical teams in high-pressure environments, strengthening communication, decision-making, and crisis management skills.
Education
Diploma - Nursing
University Malaya Medical Centre
Petaling Jaya, Selangor, Malaysia 04.2001 -
Skills
Inpatient claims assessment
Proficient in ICD-10 and CPT code interpretation
Clinical document interpretation
Adept at identifying inconsistencies in medical records
Skilled in interpreting coverage rules and conditions
Cross-functional team collaboration
Timeline
Return/Refund (RR) Fraud Lead
Shopee
12.2023 - 04.2025
Claims and Customer Service Lead
BIMA (Milvik MY)
10.2021 - 10.2023
Medical Claims Executive/Assessor
AIA Health Services
09.2017 - 05.2021
Registered Nurse
University Malaya Medical Center (UMMC)
07.2014 - 09.2016
Diploma - Nursing
University Malaya Medical Centre
04.2001 -