Manager (Case Management-clinical)

2 days ago

Singapore Parkway Pantai Full time

Perform first line medical review for clients including pre-admission case review, determination of medical necessity, panel fee adherence, bill adjudication and case negotiation
- Act as main liaison between Medical Director, Operations Manager and key external stakeholders (providers and payers) to provide key case details to facilitate timely approval and processing of claims
- Communicate professionally and courteously with external clients and internal partners
- Assist with case tracking, monitoring and reporting
- Support learning and development program and participate in ongoing education, knowledge sharing and continuous improvement initiatives
- Provide professional medical input to support operational efficiencies (may include development of digital platforms)
- Support Marketing/Sales team in their business acquisition efforts from a medical case management perspective
- Knowledge and adherence to company policies and procedures
- Achieve relevant objectives /KPI’s as outlined by direct manager

**Key accountabilities**:

- Respond to all medical enquiries from claims team within 1 working day
- Update payers of case status within specified SLAs
- Source relevant clinical information as requested by payers
- Ensure cases are all in order to allow them to be e-filed within specified target timeframe
- Reviews are accurate with high detection of potential cost saving opportunities
- For complex cases, ensure ongoing follow-up to effect amicable case resolution within mutually negotiated timeframe
- Demonstrate the value of the case management team to clients by providing reporting which supports quantitative results (eg cost savings)
- Maintain good working relationships with partners and create win-win situations
- Be open-minded to opportunities for innovation and initiate projects that offer solutions to pain points
- Collaborate with Central Commercial Team in new business partnerships

**Qualifications & Experience**:

- Nursing Degree or similar clinical qualification
- At least 5 years of experience in healthcare industry, with at least 2 years working in a clinical setting
- Experience with insurance claim processing would be an advantage
- Understanding of Singapore healthcare system including Table of Surgical Procedures (TOSP) and MOH Fee Benchmarks
- Pays attention to details with ability to pick up on specific omissions or errors
- Good communication skills in English (both spoken and written); other languages expertise as added advantage
- Good planning and highly organized with the ability to multi-task and work in fast-paced and result driven environment
- Analytical minded, able to think ‘outside-the-box’ for issues management, performance driven.
- Good interpersonal skills and able to interact efficiently
- Service oriented (customer-centric) with high standard of expectations

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