Training, Case Management & Ops Sop Governance, Analyst

AIA

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5 years health claims management experience
Knowledge of moh guidelines and 13th schedule
Strong analytical and audit skills for fraud detection
** AIA is seeking a Training, Case Management & Ops Sop Governance Analyst to enhance operational excellence and customer satisfaction in health claims management. The role involves training assessors, managing complex policy cases, and implementing process improvements while fostering a culture of compliance and efficiency. **

Job Summary

  • The role is responsible for determining operational excellence and customer satisfaction by empowering assessors through continuous training.
  • Candidates will handle complex policy cases requiring special investigative skills to prevent fraud, waste, and abuse.
  • The position involves interpreting Ministry of Health directives and providing medical advisory for disputed charges.

Matching Summary

Match Score: 75

** AIA is seeking a Training, Case Management & Ops Sop Governance Analyst to enhance operational excellence and customer satisfaction in health claims management. The role involves training assessors, managing complex policy cases, and implementing process improvements while fostering a culture of compliance and efficiency. **

Skills & Requirements

Must-have

  • 5 years health claims management experience
  • Knowledge of MOH guidelines and 13th Schedule
  • Strong analytical and audit skills for fraud detection
  • Experience with medical advisory and dispute resolution
  • Proficiency in MS Office and claims platforms

Nice-to-have

  • Medical degree advantageous but not mandatory
  • Prior audit or quality assurance experience preferred
  • Ability to mentor TLs and assessors
  • Collaboration with government authorities for investigations
  • Commitment to sustainability and community health

Key Requirements

  • Bachelor's degree in health sciences or equivalent
  • Minimum 5 years in health claims or clinical advisory roles
  • Industry-related medical or healthcare certification preferred
  • High proficiency in report automation tools
  • Excellent communication and stakeholder management skills

Work Rights

Not specified

Tailored Resume

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