Process Improvement and Transformation Specialist
1 day ago
Job Description
- Review all system related feedback/escalation, from claim assessors and servicing team.
- Work with tech team/Business Analyst to investigate on issue.
- Collaborate with tech team to identify interim solution and permanent solution.
- Raise Remedy Force ticket and monitor all outstanding tickets.
- Prepare necessary forms for table lifting and DFU.
- Monitor and track all open DFU/Table Lifting with proper record of all DFU performed by PRUShield claims team.
- Coordinate with claim assessors and tech teams on DFU process.
- Review and sign off when DFU is completed.
- Work with tech team on regular table lifting (daily)
- Review and ensure process is completed before providing sign off when table lifting is completed
- Maintain of data in LifeAsia/Jireh system - panel/non-panel/Extended panel list
- Ensure timely updates of data provided by MOH in system – Clinics, Cancer Drug List, TOSP/ICD Codes
- Identify opportunities for the prevention of Fraud, Waste and Abuse (FWA) within Prushield Claims to control the financial and reputational risk
- Translate FWA business logics into system rules and work with the relevant stakeholders for the deployment of the rules in the production system
- Collaborate with the QA Tester to ensure and validate the accuracy of the test results in the UAT environment prior to the deployment in the production
Who we are looking for
Competencies & Personal Traits
- System related knowledge is an advantage
- Able to work closely with different team
- Ability to work in a fast pace environment with tight deadlines
Working Experience
- Minimum 2-3 years of experience, a must to have experience in health/shield claims
Education
- Bachelor's Degree
Excellent Communication Skills
Powerhouse
Management Skills
TMT
UAT
Analytical Skills
Process Improvement
Business Acumen
Business Process Reengineering
Business Process Improvement
Advocate
Fraud
Prevention
Automated Processes
Six Sigma
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