Medical Claim Examiner

2 days ago


Singapore beBeeCareer Full time $60,000 - $100,000
Job Overview

We are seeking a seasoned Medical Adjudication Specialist to join our team.

About the Role:

  • The selected candidate will be responsible for reviewing and adjudicating complex medical claims to identify potential fraud, waste, or abuse.
  • They will collaborate with medical providers and internal stakeholders to investigate questionable claims and perform fact-finding.
  • Negotiations with service providers on unreasonable charges and challenging inflated or non-medically necessary items will also be a key responsibility.
  • Applying evidence-based clinical knowledge to support fair, consistent decisions is crucial in this role.
  • Effective communication and negotiation skills are essential to explain adjudication outcomes and ensure clarity.
  • The ideal candidate will contribute insights to the development of automated adjudication tools and continuous process improvements.
  • Meeting Service Level Agreements (SLAs) for claims adjudication, reporting, and closure is also an important aspect of this job.
  • Expert recommendations on emerging Fraud, Waste, and Abuse (FWA) trends and proposing preventive strategies will be highly valued.

Key Requirements:

  • Candidates must have 3-5 years of clinical or operation theatre experience in Singapore.
  • A strong understanding of surgical codes is essential.
  • Strong clinical reasoning and analytical thinking are required.
  • Excellent communication and negotiation skills are necessary.
  • Computer literacy – Microsoft Word and Excel is a must.
  • Insurance-related and health insurance adjudication experience is advantageous.
  • This role is suitable for nurses looking for a career change.

What We Offer:

  • A dynamic work environment with opportunities for growth and development.
  • A competitive salary and benefits package.
  • A chance to make a meaningful impact in the healthcare industry.


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