Associate, Medical, Fraud and Knowledge Management
Bring your career aspirations to life with AIA!
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 ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned
- To achieve team target Savings benchmark
- To performs other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements
- 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.
Minimum Job Requirements
- To participate in analysis and audits that are pertinent to cost savings across various units in AIA.
- Good knowledge of current healthcare delivery systems and hospital management and billing system would be an advantage
- 2 - 3 years of working experience in the service industry, preferably in healthcare or insurance
- Good communication and interpersonal skill
- Basic computer skill
- Able to work with minimum supervision
- Able to work on shift
- Good team player
- Able to work under pressure
Build a career with us as we help our customers and the community live healthier, longer, better lives.
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