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26 Nov 2020
Medical Network Provider Management
SingaporePermanent PositionHealth insurance is a major focus for the organization and you will be part of an exciting team to drive and execute initiatives to achieve long term claims cost containment and support the business strategies while delivering quality claims service for the organization and creating value for our customers.
You will handle pre-authorization approval for integrated shield claims and interact with patients, hospital personnel and third party administrator to ensure patient obtains pre-authorization in accordance with the medical insurance coverage. You will also be responsible to assess complex medical claims, provide medical opinion to a team of claim assessors and to uplift the medical competencies of the department to deliver quality claims service.
Expires on 26 Dec 2020
- Provide medical advice to claims assessors on day to day claim matters;
- Manage and provide accurate and timely assessment of pre-approval of health claims;
- Manage specialized claim investigation including complex and high value claims;
- Effectively manage and work with our business partners to develop a comprehensive Health Connect panel of specialists to ensure policyholders access quality care for insured treatment;
- Effectively manage and work with appointed third party administrator, hospitals and clinics to drive utilization of Health Connect services and ensure service levels for Health Connect services and claims cost containment goals are met;
- Assist in-house medical consultant to formulate fee schedules and develop medical guidelines for coverage medically required treatment based on current sound medical practice and evidence based medicine principle;
- Participate and implement service excellence initiatives and cost effective strategies to achieve for Health Connect Services and process efficiency;
- Constantly looking out and keep up-to-date with the industry and market changes to seek new opportunity to improve service quality and proposition;
- Devise training programmes and delivery of the same in line with the team’s training needs to build team’s medical competency;
- Deliver excellent service and enhance customer and distribution channels relationship management;
- Ensure compliance with internal and external regulatory and legal matter;
- Takes accountability in considering business and regulatory compliance risks and takes appropriate steps to mitigate the risks;
- Maintains awareness of industry trends on regulatory compliance, emerging threats and technologies in order to understand the risk and better safeguard the company; and
- Highlights any potential concerns /risks and proactively shares best risk management practices.
Posted ByShirley Tan Siaw Chin (Reg No: R1658715)
Tel: +65 6738 email@example.com
- Bachelor’s Degree in Medicine or Diploma in Nursing or other medical and health sciences related fields;
- At least 5 years of clinical practice in own field and 3 years of working experience in the insurance industry with sound knowledge in life and medical claims;
- Working knowledge of medical business office procedures and basic accounting, and detailed understanding of ICD and CPT codes;
- Relevant experience at medical provider management in Singapore or claims management and knowledge in healthcare fee structure in Singapore is preferred;
- Strong ability to explain medical conditions in insurance context;
- Strong analytical, negotiation, business writing, presentation and IT (MS office) skills;
- Customer-centric and meticulous with the ability to work under pressure;
- Leadership ability and a good team player;
- High level of integrity, takes accountability of work and good attitude over teamwork; and
- Takes initiative to improve current state of things and adaptable to embrace new changes.
Location : Singapore
If the above speaks to you, we'd love to hear from you. Please send in your updated CV to firstname.lastname@example.org or email@example.com (Shirley Tan Siaw Chin, Reg No: R1658715 / Glenn Wong, Reg No: R1106685). You may email this great opportunity to someone who would be a great fit for this role.
All information will be kept strictly confidential. We regret to inform that only successful applicants will be contacted.
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