Medical Advisory, Case and Fraud Management, Analyst
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 Role
Responsible for performing pre-certification; prospective, concurrent, and retrospective review of hospitalization; and to ensure cost containment measures are carried out without compromising on the care quality and service standards.Responsibility
To pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company’s requirements and guidelines
To lead the team and manage rostering / OT and FTE count needed for AGL and ADR
To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned
To achieve team target Savings benchmark
To monitor of length of stay, reasonable and customary charges, to ensure there is no abuse in terms of admission and procedures During the adjudication of AGLs and ADR
To mentor/coach and guide the TLs and assessors in robust decision making
To ensure all guides and Cost savings initiatives are followed closely by Team leader and assessors
To participate in outlining Medical training /roll downs according to the needs of the staffs
To participate in analysis and audits that are pertinent to cost savings across various units in AIA
To participate in process improvement initiatives pertaining to system enhancement and refining process flow for the team
To collaborate with various units in AIA in ensuring cost savings and CAR is achieved.
To participate in workshops/seminars and discussion in cost saving initiatives/Fraud, waste and abuse matters
To lead the Fraud, Waste and Abuse initiatives in conducting analysis
To performs other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements
Minimum Job Requirements
Education: Bachelor's Degree in Administrative Studies, Biomedical / Technical Science, Nursing
Years of Experience: Minimum 3 years of relevant experience
Technical Skills: guarantee letter issuance, healthcare delivery systems, hospital management, billing system
Industry: Health Insurance, Third-Party Administrator, Hospitals
Language: English and Bahasa Malaysia
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.
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