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Claims Rules Analyst
3 weeks ago
ORGANISATIONAL INFORMATION
As the holding company of Singapore's public healthcare institutions, we are always looking for qualified, passionate individuals who are keen to make a valuable contribution to public healthcare. At MOH Holdings, we believe our employees are our greatest asset and we are dedicated in helping them achieve their full potential through professional development and by providing an environment to develop their leadership skills and competencies.
JOB OVERVIEW
Reporting to the Team Lead of the Claims Management Office, the Claim Rules Analyst supports appropriate care through our national financing schemes through development and promulgation of MediShield Life Claims Rules. The officer will also perform analysis on past claims data to identify egregious claiming patterns and to monitor the effectiveness of claims guidance over time following implementation.
JOB RESPONSIBILITIES
Perform clinical literature review from international guidelines and produce preliminary draft of claims rules
Research of relevant international claims guidelines, e.g. UK NICE guidelines, Irish and Australian medical insurance Claims Rules and published medical literature for cost and clinical effectiveness
Review published medical literature and journals for cost and clinical effective treatment option
Draft the Claims Rules based on research of guidelines and literature in consultation with clinician/experts workgroups and internal MOH staff
Data analysis on claims
To identify egregious claim patterns and apply insight for claims rules development
To assess feasibility of implementation of claim rules using historical claims data
To quantify potential cost-savings through claim rules
Conduct stakeholder consultations
To provide secretariat support during Claims Rules Workgroup discussions
To illicit key points of discussion and engage stakeholders for consultation to arrive at a consensus
Collate inquiry and inputs from respective stakeholders to be incorporated into the claims rules draft
Produce senior management policy papers rationalising Claims Rules
Apply systems thinking in producing senior management policy papers
Work collaboratively with various stakeholders in incorporating inputs for drafts
Seek senior management approval on the final draft of claims rules and other related submissions
Engagement and education of stakeholders in understanding final promulgated Claims Rules
Publish claims rules and respond to feedback during implementation
Drive offline and online education efforts to enhance awareness and understanding of claims rules
JOB REQUIREMENTS
Education Requirement(s):
Basic University Science Degree, highly advantageous if candidate is a healthcare professional (MBBS or equivalent, Pharmacy degree, or Life Sciences PHD) or health economist
Medical doctors, pharmacists or healthcare professionals familiar with surgical procedures and/or with research background is preferred to critically appraise evidence and support clinical workgroup discussions
Understanding of Health Finance Policy, Pharmacoeconomics and Health Technology Assessment principles is a significant advantage
Experience in statistical analysis with demonstrated competency in using statistical tools such as Python or Tableau will be advantageous
Other requirements / qualities:
Perspective gathering
Analytical and critical thinking
Able to collaborate and work with internal and external stakeholders
Effective oral and written communication
Project management – prior experience in (a) assigning roles and responsibilities, (b) managing and liaising with multiple stakeholders for inputs / clarifications, (c) monitoring timelines and progress, and (d)dealing with clinical/medical related projects
The appointed job title (Executive / Senior Executive / Manager) will be determined based on the candidate's qualifications and relevant experience.
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