Sr. Specialist - AAGI A&H Hospital & Claim Audit

Job description

Job Summary : The position holder is responsible to ensure providers are providing the best possible treatment for Allianz  and price guidelines with high levels of quality based clinical outcomes

Responsibilities :

'1) Clinical Quality
•    Develop and implement a clinical quality strategy, which assures our members that they are receiving high quality and appropriate care.
•    Ensure that all treatment and care given to our members including admission to hospital is appropriate and in accordance with agreed
protocols.
•    Encourage clinical best practice by providing analytical feedback hospitals, clinics and doctors on clinical practice including procedural costs, length of
stays and outcomes.
•    Ensure that all hospitals and clinics in our network meet our standards of care and take necessary action when the care given is below standard.
•    Ensure that any new clinical procedures, drugs or technology are appropriate and safe for our customers
•    To review and manage the treatment of high claiming members to ensure that their treatment is appropriate
'2) Clinical Audit
•    Carry out clinical audits on both provider network and non- provider network, ensuring that Allianz customer receive high quality and appropriate treatment and care at an affordable price.

'3) Clinical Governance scheme
     Attend the pool insurance meeting as schedule
     Attend claim and clinical committee as team member

Qualifications :

• Bachelor’s or Master’s Degree in Nursing

• At Least  3-5 yrs of experience in Nurse in hospital and insurance industry experience will be advantage

AAGI