Medical Advisory, Case & Fraud Management, Specialist
AIA
Pre-certification and hospitalization review
Fraud waste and abuse analysis
Team rostering and fte management
The role is responsible for performing pre-certification and reviewing hospitalization cases to ensure cost containment without compromising care quality
Job Summary
The role is responsible for performing pre-certification and reviewing hospitalization cases to ensure cost containment without compromising care quality.
Candidates will lead the team in managing rostering, OT, and FTE counts while ensuring guarantee letters are issued accurately within targeted turnaround times.
The position involves leading fraud, waste, and abuse initiatives through robust analysis and participating in process improvement efforts to refine system flows.
Matching Summary
The role is responsible for performing pre-certification and reviewing hospitalization cases to ensure cost containment without compromising care quality.
Skills & Requirements
Must-have
Pre-certification and hospitalization review
Fraud waste and abuse analysis
Team rostering and FTE management
Guarantee letter issuance accuracy
Length of stay monitoring
Nice-to-have
Process improvement initiative participation
Mentoring and coaching skills
Collaboration across business units
Workshop facilitation experience
Key Requirements
Experience in medical advisory or case management
Knowledge of insurance guidelines and compliance
Leadership experience managing assessors and teams