Training, Case Management & Ops Sop Governance, Analyst

AIA

Not specified
5+ years health claims management experience
Knowledge of moh guidelines and 13th schedule
Fraud, waste and abuse investigation skills
AIA is seeking an Analyst for Training, Case Management & Ops SOP Governance who will focus on enhancing operational excellence and customer satisfaction in health claims management. The role involves continuous training, auditing, and fraud prevention, requiring a strong background in health sciences and claims management

Job Summary

  • The role is responsible for determining operational excellence and customer satisfaction by empowering assessors through continuous training.
  • Candidates must handle complex policy cases requiring special investigative skills to prevent fraud, waste, and abuse in line with Ministry of Health directives.
  • The position involves providing basic medical advisory for claims teams on disputed charges and appeals while ensuring compliance with reasonable and customary charges.

Matching Summary

Match Score: 85

AIA is seeking an Analyst for Training, Case Management & Ops SOP Governance who will focus on enhancing operational excellence and customer satisfaction in health claims management. The role involves continuous training, auditing, and fraud prevention, requiring a strong background in health sciences and claims management.

Skills & Requirements

Must-have

  • 5+ years health claims management experience
  • Knowledge of MOH guidelines and 13th Schedule
  • Fraud, Waste and Abuse investigation skills
  • Medical advisory for disputed charges
  • Process improvement strategy implementation

Nice-to-have

  • Prior audit or quality assurance experience
  • Mentoring and coaching team members
  • Collaboration with government authorities
  • Strong stakeholder management capabilities
  • Experience with third-party investigations

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 MS Office and claims platforms

Work Rights

Not specified

Tailored Resume

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