PROTECTHEALTH CORPORATION SDN. BHD. is looking for new potential candidates to fill in for Executive, Medical Audit position. If you currently looking for new healthcare job opportunities and qualified with the job desc, feel free to apply this job.
Accountable in a quality improvement process with an analysis against explicit criteria of cost and quality of care that improve the financial risk protection for an effective and efficient healthcare system and healthcare delivery.
- Support and assist in clinical audit to ensure the treatment follow the latest Clinical Practice Guideline (CPG) provided by Ministry of Health.
- To carry out the post-pay audit and medical audit for specific disease to compare the differences of claim, treatment and outcome.
- Working together with Standard, Quality and Accreditation Department (SQA) to develop criteria for accreditation of providers.
- Developing the visit team that will involve SQA and other relevant departments of the Company.
- Monitoring Third Party Claims Administrator (TPCA) claims for Skim Perlindungan Insurans Kesihatan Pekerja Asing (SPIKPA)
- Identify trigger based on quality and appropriateness of health care services provided and not just financial triggers.
- Esure the claim submission system will include the variable/entry that show how the treatment/management had follow the CPG.
- To check/confirm if new variable can be added to the exiting SPIKPA system.
- To monitor the weekly and monthly report of claim submission.
- To run of post-pay audit of selected disease/treatment, any outlier claim or random sampling.
- Present the finding to management committee/CEO and the proposal on how to make it better
- To ensure the new core system/ claim system of the Company will have the variable/entry
- Carry out site visit to monitor / help / educate for better claim and treatment submission can be achieved.
- Working together with SQA department on improving the provider facility performance.
- A Bachelor’s degree preferably in medicine, pharmacy or audit related field.
- Preference with a minimum of 3 years working experience in Takaful / Insurance / TPCA / Healthcare industry.
- Ability to manage multiple tasks and meet demands of a fast-paced environment with changing priorities.
Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly-owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).
As a not-for-profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.
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