MiCare Sdn Bhd (a member of Zuellig Pharma Group) is looking for new potential candidates to fill in for Manager, Medical Support position. If you currently looking for new healthcare job opportunities and qualified with the job desc, feel free to apply this job.
- You will lead and manage teams comprising of medical doctors and medical audit.
- You will work closely with the operations providing effective and efficient medical support, meeting the benchmark for the service and standards required.
- You will act as an Advisor/Consultant providing medical input and advice on cases relating to operations, medical audit and service provider team.
- You will promote business growth and build trust with internal/external stakeholders of the company.
- You will ensure adherence to all regulatory requirement and governance, both local and group level.
- To ensure consistency in all medical claim cases, business integrity is upheld and due diligence is met on any related regulatory requirement.
- To assist in dealing with and resolving complex medical claim cases sharing views and recommendation to the best of medical knowledge and expertise.
- To provide assessment review and to improve quality justification of claim in order to meet expectations on operational processes.
- To plan and conduct training to improve staff medical knowledge and competency with case study relating to diagnosis, 13th Schedule.
- Provide support to operation team, ensure adherence to and update when necessary the procedural steps to meet the standards required for the medical claims assessment.
- Provide medical advice on claims cases, responsible for queries and correspondence with hospitals and doctors, review and resolve any dispute or challenges related to charges and practices.
- To ensure consistency in the admission procedures and claim adjudication that charges are reasonable and aligned with the schedule of benefits.
- Study and analyse trending of doctors through data on claims for any signs of overuse and up coding, investigate if required.
- Gather industrial intelligence, profiling medical practitioners, prepare reports as and when required.
- To establish guides and initiatives related to cost containment measures across teams within operations, assist team in decision making.
- To ensure continuous learning and upgrade of knowledge needed to support the daily operation through coaching, guides and reference cases.
- To perform initiatives on analysis relating to abuse, fraud and waste, and audit relating to cost savings across operations.
- Assist with medical response to crisis management and other acute medical issues.
- To ensure compliance to the local and group policies and regulatory requirements.
- To promote communication and close collaboration inter-departmentally through working together to resolve issues for the benefits of all our stakeholders.
- To participate in any other tasks and duties as assigned by the superior.
• Medical degree with valid APC
• Minimum 5 years working experience
• Knowledge and experience in medical claims/insurance will be an added advantage
• Effective communication skills essential, both written and oral
• Result driven
• Strong interpersonal/influencing and presentation skills
• Hands-on exposure in clinical trials, people managerial skills and issue solving.
• Self-motivated, able to work with minimum supervision, good team player.
How To Apply
If you confident and feel that this job is suitable to you, go ahead take your action now.
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