Associate, Health Claims Management
5 days ago
**At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.**
**Sound like you Then read on.**
**WE ARE LOOKING FOR.....**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.
**Roles and Responsibilities**
- 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 roastering / 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 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.
- To participate in analysis and audits that are pertinent to cost savings across various units in AIA.
- To participate in process improvement intiatives 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.
**Financial and Non-Financial Measures**
- GL authority limit to below RM 10,000
- Additional Guarantee letter and Cross Referrals issuance meeting set Standard TAT 90% of the time
- Average GL processing productivity to meet set benchmark 90% of the time
- To acquire at least 10 hours of training every year
**Communication Requirements**
- Contacts with all levels of positions (Admin, Marketing, Claims, Call Centre, Provider Management) in Life Claims, Corporate Solution Department and AHS Department
- Contacts with Hospital Providers (Billing dept, Front Office)
- Contact with Individual reimbursement team/ CSD/ MPC and GL operations.
**Minimum Job Requirements**
- 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
- This is one year contract position
**Reporting Structure and Supervisory / Managerial Responsibilities**
- Reports to Manager, Medical Advisory, Case & Fraud Management
- No. of direct reports - Nil
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