1. Medical/Regulatory Oversight (Claims Management, Medical Auditing & FWA Identification)
Serve as Clinical Governance Officer (CGO) for all IHP clinics
Lead audit preparation and execution to ensure regulatory compliance
Act as the ordering doctor for laboratory and imaging tests, including prompt responses to critical results
Address general medical regulations queries from internal and external stakeholders
Lead initiatives to manage and reduce the cost of medical claims through clinical review, provider negotiation, and strategic interventions.
Conduct and oversee claims audits, identifying patterns of overutilization or fraud, waste, and abuse (FWA).
Monitor provider performance and billing behavior to identify and mitigate fraud, waste, and abuse (FWA); initiate corrective actions where necessary.
Develop internal cost containment SOPs and workflows in collaboration with operational teams to streamline claims processing and medical adjudication.
Act as the primary client-facing representative for all matters related to medical cost containment.
Prepare regular reports and presentations for leadership and clients, highlighting key cost drivers, trends, and opportunities for optimization.
2. Clinical Support
Review Patient Information Leaflets (PIL)
Perform regular medication reviews and sign off for VIP, ensuring safe and effective treatment plans
3. Claims, LOG and Pre-Authorization
Act as the final medical escalation point for claims, LOG, and pre-authorization within IHP
Develop and refine general guidelines and definitions for medical reimbursable claims
Provide strategic support to the Claims and LOG teams in developing and enhancing STP workflows and overall process improvements
4.
Business Development Support
Participate in presentations and stakeholder engagement as a clinical representative
Collaborate on workflow reviews to align clinical operations with BD initiatives
Contribute to the ongoing refinement of IHP's data analytics, offering client insights and actionable strategies.
Provide KIV support for on-site rollout of services
Participation in initiative-based projects as required, including clinical input and representation in BD-related presentations and discussions.
5. Medical Services Program
Involvement in design, execution, and evaluation of new medical programs or processes, such as Chronic Disease Program and Letter of Pre-Authorization (LPA) Program.
Support for program rollout and ensuring medical compliance with local regulations.
Job Requirements:
Medical Degree from a recognized university (MD or MBBS preferred)
Minimum 5 years of relevant experience in TPA or insurance company
Willingness to support after-office-hours remotely
Willing to travel to Singapore at least once a month.