Job Description
We provide managed healthcare services to corporate clients ranging from SMEs to MNCs.
Responsibilities:
1. Medical/Regulatory Oversight
- Serve as Clinical Governance Officer (CGO) for all our 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 contai...