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Medical Advisor
2 weeks ago
What You'll Be Doing
As a Medical Advisor, you'll be at the heart of our medical operations. Your responsibilities will include:
Medical/Regulatory Oversight
- Serve as Clinical Governance Officer (CGO) for all IHP clinics
- Lead audit preparation and execution to ensure regulatory compliance
- Act as the ordering doctor for laboratory and imaging tests, including prompt responses to critical results
- Address general medical regulations queries from internal and external stakeholders
- Lead initiatives to manage and reduce the cost of medical claims through clinical review, provider negotiation, and strategic interventions.
- Conduct and oversee claims audits, identifying patterns of overutilization or fraud, waste, and abuse (FWA).
- Monitor provider performance and billing behavior to identify and mitigate fraud, waste, and abuse (FWA); initiate corrective actions where necessary.
- Develop internal cost containment SOPs and workflows in collaboration with operational teams to streamline claims processing and medical adjudication.
- Act as the primary client-facing representative for all matters related to medical cost containment.
- Prepare regular reports and presentations for leadership and clients, highlighting key cost drivers, trends, and opportunities for optimization.
Clinical Support
- Review Patient Information Leaflets (PIL)
- Perform regular medication reviews and sign off for VIP, ensuring safe and effective treatment plans
Claims, Letter of Guarantee (LOG) and Pre-Authorization
- Act as the final medical escalation point for claims, LOG, and pre-authorization within IHP
- Develop and refine general guidelines and definitions for medical reimbursable claims
- Provide strategic support to the Claims and LOG teams in developing and enhancing STP workflows and overall process improvements
Business Development Support
- Participate in presentations and stakeholder engagement as a clinical representative
- Collaborate on workflow reviews to align clinical operations with BD initiatives
- Contribute to the ongoing refinement of IHP's data analytics, offering client insights and actionable strategies.
- Provide KIV support for on-site rollout of services
- Participation in initiative-based projects as required, including clinical input and representation in BD-related presentations and discussions
Chronic disease management program- Involvement in design, execution, and evaluation
LPA program- Support for program rollout and medical compliance
What You Need to Excel
We're looking for someone who is:
- Confident and self-motivated
- Calm under pressure (equanimity)
- Tech-savvy and adaptable
- A great communicator with strong interpersonal skills
Qualifications & Requirements
- Medical Degree from a recognized university (MD or MBBS preferred)
- Minimum 5 years of relevant experience in TPA or insurance company
- Willingness to support after-office-hours remotely
- Willing to travel (Singapore)
Why Join Us?
- Be part of a passionate and collaborative medical team
- Make a real difference in people's lives
- Enjoy a supportive work environment with opportunities for growth
Job Type: Full-time
Pay: RM10, RM15,000.00 per month
Application Question(s):
- What is your expected salary?
Work Location: In person
