Specialist Management, Specialist

AIA

Not specified
Medical coding proficiency
13th schedule knowledge
Moh letters expertise
AIA is seeking a Specialist in Management to focus on detecting fraud, waste, and abuse within healthcare claims processing. The ideal candidate will have a background in health sciences and relevant industry experience, along with strong analytical and communication skills

Job Summary

  • The role is responsible for detecting Fraud, Waste and Abuse while conducting analysis with proper cost containment measures.
  • Candidates must be well-versed with medical coding, 13th Schedule, MOH letters, and reasonable and customary charges to ensure claim adjudication compliance.
  • The position involves mentoring TLs and assessors in robust decision making while proactively identifying system enhancements and process automation needs.

Matching Summary

Match Score: 75

AIA is seeking a Specialist in Management to focus on detecting fraud, waste, and abuse within healthcare claims processing. The ideal candidate will have a background in health sciences and relevant industry experience, along with strong analytical and communication skills.

Skills & Requirements

Must-have

  • Medical coding proficiency
  • 13th Schedule knowledge
  • MOH letters expertise
  • Reasonable and customary charges
  • Fraud waste and abuse detection
  • Claims adjudication experience

Nice-to-have

  • Strong verbal communication skills
  • Problem solving abilities
  • People management capabilities
  • Fundamental accounting knowledge
  • Willingness to travel for assignments

Key Requirements

  • Degree in Health or Life Sciences
  • Experience in healthcare or managed care industry
  • Knowledge in healthcare management
  • Experience in nursing and medical advancement

Work Rights

Not specified

Tailored Resume

Cover Letter