Manager, Medical Advisor & Case Management (candidates with medical background and ideally has [...]

Important note: Candidate must have an active Annual Practice License/Certificate.

About the job

To provide medical consultation and opinion in regard to claims pertinent to Guarantee Letter (GL) or Reimbursement / medical claim disputes or appeals / investigations / underwriting, and to ensure effective implementation of case management intervention in order to efficiently reduce or contain healthcare cost, without compromising healthcare quality and needs, in addition to development of quality assurance programmes or other relevant initiatives for organization.

• Medical advisory lead within and beyond operations divisions. To provide medical insights to various divisions within the company such as Medical Claims, Network Management, Call Centre, Customer Services, Product Management & Pricing, Strategic Business Development etc.
• To monitor and follow up with complex cases that require prolonged stay or due for discharge based on ...