Job Description
Role Description
- Overseeing relationships and performance with third-party administrators (TPAs) to ensure effective claims processing and service delivery.
- Provide medical expertise to support claims assessment, policy development, and product design.
- Working closely with across function such as, CMT, Claims, Underwriting, Customer service, and Provider Relations.
- Reviewing medical cases and giving valid decision.
- Providing data analysis of medical cost trends, utilization patterns, and fraud cases.
- Providing recommendations for standard medical fees and cost containment.
Qualifications
- The candidates must have Medical Doctor (MD) background.
- The candidates have minimum 5 years experience in handling TPAs, Case Management, and Provider Management.
- Proficiency in English.
- Comfort working with digital tools and data-driven workflows.
- Knowledge of cost containment strategies in health insurance.
- Strong analytical thinking and high attention to detail.
- Presentation and communication skill.
