Job Description

The Role

• Perform first line medical review for clients including pre-admission case review, determination of medical necessity, panel fee adherence, bill adjudication and case negotiation
• Act as main liaison between Medical Director, Operations Manager and key external stakeholders (providers and payers) to provide key case details to facilitate timely approval and processing of claims
• Communicate professionally and courteously with external clients and internal partners
• Assist with case tracking, monitoring and reporting
• Support learning and development program and participate in ongoing education, knowledge sharing and continuous improvement initiatives
• Provide professional medical input to support operational efficiencies (may include development of digital platforms)
• Support Marketing/Sales team in their business acquisition efforts from a medical case management perspective
• Knowledge and adherence to company policies and procedures
• Achieve relevant objectives /KPI\xe2\x80\x99s as outlined by direct manager

• Respond to all medical enquiries from claims team within 1 working day
• Update payers of case status within specified SLAs
• Source relevant clinical information as requested by payers
• Ensure cases are all in order to allow them to be e-filed within specified target timeframe
• Reviews are accurate with high detection of potential cost saving opportunities
• For complex cases, ensure ongoing follow-up to effect amicable case resolution within mutually negotiated timeframe
• Demonstrate the value of the case management team to clients by providing reporting which supports quantitative results (eg cost savings)
• Maintain good working relationships with partners and create win-win situations
• Be open-minded to opportunities for innovation and initiate projects that offer solutions to pain points
• Collaborate with Central Commercial Team in new business partnerships

• Nursing Degree or similar clinical qualification
• At least 5 years of experience in healthcare industry, with at least 2 years working in a clinical setting
• Experience with insurance claim processing would be an advantage
• Understanding of Singapore healthcare system including Table of Surgical Procedures (TOSP) and MOH Fee Benchmarks
• Pays attention to details with ability to pick up on specific omissions or errors
• Good communication skills in English (both spoken and written); other languages expertise as added advantage
• Good planning and highly organized with the ability to multi-task and work in fast-paced and result driven environment
• Analytical minded, able to think \xe2\x80\x98outside-the-box\xe2\x80\x99 for issues management, performance driven.
• Good interpersonal skills and able to interact efficiently
• Service oriented (customer-centric) with high standard of expectations

Parkway Shenton