Medical Claims Examiner

5 days ago

Singapore beBeeClinical Full time $90,000 - $120,000
Medical Adjudication Specialist

Transforming the Future of Healthcare Together:

We're on a mission to create a healthier, more sustainable future for everyone. Our vision is to help a billion people live Healthier, Longer, Better Lives by 2030.

To achieve this ambitious goal, we need talented individuals who share our passion for making a difference. If you're driven to work with, and learn from, some of the most inspiring and supportive leaders in the industry, then read on.

About the Role:
  • Perform accurate adjudication of complex medical claims to identify 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, 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, AI-driven fraud detection, and continuous process improvements.
  • Meet Service Level Agreements (SLAs) for claims adjudication, reporting, and closure.
  • Provide expert recommendations on emerging FWA 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.
  • Effective communication and negotiation skills, especially when dealing with policyholders, agents, and healthcare providers.
  • Computer literacy in Microsoft Word and Excel.
  • Proficiency in written and spoken English.

Join us as we strive to make a positive impact on the lives of our customers and the community. Please provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to do so may influence the processing and outcome of your application. You are responsible for ensuring that the submitted information is accurate and up-to-date.

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