Medical Claims Analyst

7 days ago


Singapore beBeeFraud Full time $80,000 - $120,000

The Medical Adjudication Specialist is responsible for reviewing and adjudicating complex medical claims, ensuring fair and consistent decisions in accordance with company policy and regulatory frameworks.

Key Responsibilities

  • Review and adjudicate 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.
  • Lead discussion with agents, administration teams, and policyholders to explain adjudication outcomes.
  • Contribute insights to the development of automated adjudication tools, AI-driven fraud detection, and continuous process improvements.
  • Meet SLA timelines for claims adjudication, reporting, and closure.

Requirements

  • 3-5 years of clinical or operation theatre experience in Singapore.
  • Strong understanding of surgical codes.
  • Strong clinical reasoning and analytical thinking.
  • Communication and negotiation skills.
  • Computer literacy – Microsoft Word and Excel.
  • Insurance-related and health insurance adjudication experience a plus.

Benefits

  • Suitable for nurses looking for a career change.

Skills

  • Fraud investigations.
  • Claims management.
  • Engaging with stakeholders.
  • Microsoft Office.
  • Communications.
  • Medicine and surgery.


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