Specialist Management, Specialist

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

Sound like you? Then read on.

About the Role

•Responsible for detecting Fraud, Waste and Abuse for AIA.
• To conduct analysis with proper cost containment measures, recovery, and process improvements
• To build guides, initiatives, and alignment of claims practices related to cost savings and quality claims processing
• Medical Training and Medical Advisory within and beyond AHS
• To ensure SOPS are updated periodically.
• To support TDA/Squads and other projects as required

To ensure the Fraud tool is maintained and managed with care with insightful monthly analysis.

Well-versed with medical coding, 13th Schedule, MOH letters, reasonable and customary charges.

To conduct regular audits, and handle escalations to identify Fraud, Waste and Abuse.

To ensure claim adjudication is in accordance with reas...