MOH Holdings (Singapore) Hiring! Full Time Claims Rules Analyst in - Ricebowl

ORGANISATIONAL INFORMATION

As the holding company of Singapore’s public healthcare institutions, we are always looking for qualified, passionate individuals who are keen to make a valuable contribution to public healthcare. At MOH Holdings, we believe our employees are our greatest asset and we are dedicated in helping them achieve their full potential through professional development and by providing an environment to develop their leadership skills and competencies.

JOB OVERVIEW

Reporting to the Team Lead of the Claims Management Office, the Claim Rules Analyst supports appropriate care through our national financing schemes through development and promulgation of MediShield Life Claims Rules. The officer will also perform analysis on past claims data to identify egregious claiming patterns and to monitor the effectiveness of claims guidance over time following implementation.

JOB RESPONSIBILITIES

Perform clinical literature review from international guidelines and produce preliminary draft of claims rules

• Research of relevant international claims guidelines, e.g. UK NICE guidelines, Irish and Australian medical insurance Claims Rules and published medical literature for cost and clinical effectiveness
• Review published medical literature and journals for cost and clinical effective treatment option
• Draft the Claims Rules based on research of guidelines and literature in consultation with clinician/experts workgroups and internal MOH staff

Data analysis on claims

• To identify egregious claim patterns and apply insight for claims rules development
• To assess feasibility of implementation of claim rules using historical claims data
• To quantify potential cost-savings through claim rules

Conduct stakeholder consultations

• To provide secretariat support during Claims Rules Workgroup discussions
• To illicit key points of discussion and engage stakeholders for consultation to arrive at a consensus
• Collate inquiry and inputs from respective stakeholders to be incorporated into the claims rules draft

Produce senior management policy papers rationalising Claims Rules

• Apply systems thinking in producing senior management policy papers
• Work collaboratively with various stakeholders in incorporating inputs for drafts
• Seek senior management approval on the final draft of claims rules and other related submissions

Engagement and education of stakeholders in understanding final promulgated Claims Rules

• Publish claims rules and respond to feedback during implementation
• Drive offline and online education efforts to enhance awareness and understanding of claims rules

JOB REQUIREMENTS

Education Requirement(s):

• Basic University Science Degree, highly advantageous if candidate is a healthcare professional (MBBS or equivalent, Pharmacy degree, or Life Sciences PHD) or health economist
• Medical doctors, pharmacists or healthcare professionals familiar with surgical procedures and/or with research background is preferred to critically appraise evidence and support clinical workgroup discussions
• Understanding of Health Finance Policy, Pharmacoeconomics and Health Technology Assessment principles is a significant advantage
• Experience in statistical analysis with demonstrated competency in using statistical tools such as Python or Tableau will be advantageous

Other requirements / qualities:

• Perspective gathering
• Analytical and critical thinking
• Able to collaborate and work with internal and external stakeholders
• Effective oral and written communication
• Project management – prior experience in (a) assigning roles and responsibilities, (b) managing and liaising with multiple stakeholders for inputs / clarifications, (c) monitoring timelines and progress, and (d)dealing with clinical/medical related projects

The appointed job title (Executive / Senior Executive / Manager) will be determined based on the candidate’s qualifications and relevant experience.