Bring your career aspirations to life with AIA!

Responsible for performing pre-certification; prospective, concurrent, and retrospective review of hospitalization; and to ensure cost containment measures are carried out without compromising on the care quality and service standards.

Responsibility

• To pre-certify cases for issuance of Additional Top Up guarantee letters/ Additional Requests in compliance to Company’s requirements and guidelines

• To lead the team and manage rostering / OT and FTE count needed for AGL and ADR

• To ensure guarantee letters are issued accurately and correctly within targeted TAT and with authority assigned

• To achieve team target Savings benchmark

• To monitor of length of stay, reasonable and customary charges, to ensure there is no abuse in terms of admission and procedures During the adjudication of AGLs and ADR

• To mentor/coach and guide the TLs and assessors in robust decision making

• To ensure all guides and Cost savings initiatives are followed closely by Team leader and assessors

• To participate in outlining Medical training /roll downs according to the needs of the staffs

• To participate in analysis and audits that are pertinent to cost savings across various units in AIA

• To participate in process improvement initiatives pertaining to system enhancement and refining process flow for the team

• To collaborate with various units in AIA in ensuring cost savings and CAR is achieved.

• To participate in workshops/seminars and discussion in cost saving initiatives/Fraud, waste and abuse matters

• To lead the Fraud, Waste and Abuse initiatives in conducting analysis

• To performs other responsibilities and duties periodically assigned by supervisor in order to meet operational and/or other requirements

Minimum Job Requirements

• Education: Bachelor's Degree in Administrative Studies, Biomedical / Technical Science, Nursing

• Years of Experience: Minimum 3 years of relevant experience

• Technical Skills: guarantee letter issuance, healthcare delivery systems, hospital management, billing system

• Industry: Health Insurance, Third-Party Administrator, Hospitals

• Language: English and Bahasa Malaysia

Build a career with us as we help our customers and the community live healthier, longer, better lives.

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