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Full-Time Opportunity: This is a permanent, full-time position with a competitive package and real career growth potential.
Job Description
About The Role
- Responsible for detecting Fraud, Waste and Abuse for AIA.
- To conduct analysis with proper cost containment measures, recovery, and process improvements.
- To build guides, initiatives, and alignment of claims practices related to cost savings and quality claims processing.
- Medical Training and Medical Advisory within and beyond AHS.
- To ensure SOPS are updated periodically.
- To support TDA/Squads and other projects as required.
- To ensure the Fraud tool is maintained and managed with care with insightful monthly analysis.
- Well-versed with medical coding, 13th Schedule, MOH letters, reasonable and customary charges.
- To conduct regular audits, and handle escalations to identify Fraud, Waste and Abuse.
- To ensure claim adjudication is in accordance with reasonable and customary charges.
- To review trending of doctors who may or may not be in the watch list.