At AIA we've started an exciting movement to create a healthier, more sustainable future for everyone.Sound like you Then read on.WE ARE LOOKING FOR .....Responsible for performing pre-certification prospective, concurrent, and retrospective review of hospitalization and to ensure cost containment measures are carried out without compromising on the care quality and service standards
- Pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company's requirements and guidelines
- Lead the team and manage rostering / OT and FTE count needed for AGL and ADR
- Ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned
- Achieve team target Savings benchmark
- Performs other responsibilities and duties periodically assigned by supervisor to meet operational and/or other requirements
- Monitor of length of stay, reasonable and customary charges, to ensure there is no abuse in terms of admission and procedures During the adjudication of AGLs and ADR
- Mentor/coach and guide the TLs and assessors in robust decision making
- Ensure all guides and Cost savings initiatives are followed closely by Team leader and assessors
- Participate in outlining Medical training /roll downs according to the needs of the staffs
- Participate in analysis and audits that are pertinent to cost savings across various units in AIA
- Participate in process improvement initiatives pertaining to system enhancement and refining process flow for the team
- Collaborate with various units in AIA in ensuring cost savings and CAR is achieved
- Participate in workshops/seminars and discussion in cost saving initiatives/Fraud, waste and abuse matters
- Lead the Fraud, Waste and Abuse initiatives in conducting analysis
