Clinical Decision Specialist

2 weeks ago

Singapore beBeeAdjudicator Full time $90,000 - $120,000

Healthcare Solutions Specialist

At our organization, we're driving an exciting movement to create a healthier and more sustainable future. This involves finding innovative ways to improve people's lives and the environments we live in.

Our goal is to help a billion people live healthier, longer, better lives by 2030. To achieve this ambitious target, we need driven individuals who are eager to work with and learn from inspiring leaders.

About the Role

  • Accurately review and adjudicate complex medical claims, especially those that may involve potential fraud, waste, or abuse (FWA).
  • Collaborate with medical providers, third-party administrators, and internal stakeholders to investigate questionable claims and perform fact-finding when discrepancies arise.
  • Negotiate with service providers on unreasonable charges and challenge inflated or non-medically necessary items.
  • Apply evidence-based clinical knowledge to support fair and consistent decisions, ensuring adherence to regulatory frameworks.
  • Lead discussions with agents, administration teams, and policyholders to explain adjudication outcomes, ensuring clarity.
  • Contribute insights to the development of automated adjudication tools and continuous process improvements.
  • Meet SLA timelines for claims adjudication, reporting, and closure.
  • Provide expert recommendations on emerging FWA trends and recommend preventive strategies.

Job Requirements

  • Hold a degree in Nursing or Medicine.
  • Have a minimum of 3-5 years of clinical experience in Singapore.
  • Possess at least one year of experience in insurance-related or health insurance adjudication, though this is not mandatory.
  • Hold a health insurance-related certification, if possible.
  • Demonstrate strong clinical reasoning and analytical thinking skills.
  • Excel in communication and negotiation skills, particularly when dealing with policyholders, agents, and healthcare providers.
  • Be proficient in Microsoft Word and Excel.
  • Exhibit proficiency in written and spoken English.

Join us as we strive to make a positive impact on our customers' and the community's lives.

Please provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to do so may affect the processing and outcome of your application.

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