Specialist Management, Specialist

AIA Australia

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Medical coding proficiency
13th schedule knowledge
Moh letters expertise
** AIA Australia is seeking a Specialist Management professional to combat fraud, waste, and abuse within its healthcare insurance sector. The ideal candidate will possess relevant healthcare expertise, strong analytical skills, and effective communication abilities to support various initiatives aimed at improving claims processing and cost containment. **

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 in medical coding, the 13th Schedule, MOH letters, and reasonable and customary charges to ensure claim adjudication compliance.
  • The position involves building guides, initiatives, and alignment of claims practices related to cost savings and quality claims processing.

Matching Summary

Match Score: 75

** AIA Australia is seeking a Specialist Management professional to combat fraud, waste, and abuse within its healthcare insurance sector. The ideal candidate will possess relevant healthcare expertise, strong analytical skills, and effective communication abilities to support various initiatives aimed at improving claims processing and cost containment. **

Skills & Requirements

Must-have

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

Nice-to-have

  • Stakeholder negotiation skills
  • Process automation collaboration
  • Team mentoring capabilities
  • Cross-departmental project support
  • Travel willingness for assignments

Key Requirements

  • Degree in Health or Life Sciences
  • Experience in healthcare or managed care industry
  • Fundamental knowledge in accounting principles

Work Rights

Not specified

Tailored Resume

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