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Medical Claims Adjudication Specialist
3 weeks ago
Transform Your Career with a Rewarding Role in Medical Claims Adjudication
We are seeking ambitious professionals to join our team as Medical Claims Adjudication Specialists. In this exciting role, you will play a vital part in shaping the future of healthcare by ensuring fair and consistent decisions on complex medical claims.
- Review and adjudicate high-value medical claims to identify potential fraud, waste, or abuse.
- Collaborate with medical providers, third-party administrators, and internal stakeholders to investigate questionable claims and gather evidence.
- Negotiate with service providers to challenge inflated or non-medically necessary items.
- Apply clinical knowledge to support fair and consistent decisions, adhering to regulatory frameworks and company policies.
- Communicate effectively with agents, administration teams, and policyholders to explain adjudication outcomes.
- Contribute insights to the development of automated adjudication tools and AI-driven fraud detection systems.
- Meet Service Level Agreement (SLA) timelines for claims adjudication, reporting, and closure.
- Provide expert recommendations on emerging trends and recommend preventive strategies.
Requirements:
- Registered Nurse or Medical Officer/Doctor degree.
- Minimum 3-5 years of clinical/surgical experience in Singapore.
- At least 1 year of insurance-related or health insurance adjudication experience is preferred but not necessary.
- Health Insurance-related certification is an advantage.
- Strong clinical reasoning and analytical thinking skills.
- Excellent communication and negotiation skills.
- Proficiency in written and spoken English.
Why Join Us?
As a Medical Claims Adjudication Specialist, you will have the opportunity to work with a dynamic team that is passionate about making a positive impact on people's lives. You will be challenged to grow professionally and personally, and you will have the chance to make a difference in the lives of our customers and communities.
