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, Claims Management Office, the Claims Rules Analyst supports the development, review and implementation of MediShield Life Claims Rules.

The role sits at the intersection of clinical evidence, claims analytics, policy judgement and stakeholder engagement. The officer will review clinical literature and international claims guidance, analyse historical claims data, work with clinician expert groups and MOH stakeholders, and translate findings into clear Claims Rule proposals and senior management submissions.

The officer will also support the promulgation, education and post-implementation monitoring of Claims Rules to promote appropriate MediShield Life claims and prudent use of healthcare resources.

This role requires comfort working with ambiguity, as officers will often need to make balanced recommendations amid sparse evidence, noisy claims data, differing clinical views and operational constraints.

JOB RESPONSIBILITIES

1. Claims Rules Development

1. Conduct literature reviews of clinical guidelines, international claims guidance, health technology assessments and published medical literature.
2. Review evidence on clinical effectiveness, cost-effectiveness and appropriate indications for selected procedures.
3. Develop preliminary Claims Rule proposals based on clinical evidence, claims data and policy considerations.
4. Draft Claims Rules in consultation with clinician expert workgroups and internal MOH stakeholders.
5. Ensure Claims Rules are clear, clinically sound, operationally implementable and aligned with policy intent.

2. Claims Data Analysis

1. Analyse historical claims data to identify utilisation trends, provider variation and potential inappropriate claiming patterns.
2. Assess the feasibility of implementing proposed Claims Rules using available claims and administrative data.
3. Quantify potential impact, including claims volume, affected providers, possible cost savings and operational implications.
4. Monitor post-implementation trends to assess the effectiveness of Claims Rules and identify areas for review.
5. Ensure that analyses are decision-focused and appropriately interpreted.

3. Stakeholder Consultation and Workgroup Support

1. Provide secretariat and analytical support for Claims Rules workgroup discussions.
2. Elicit key issues, document clinical and operational inputs, and identify areas of consensus or disagreement.
3. Engage internal and external stakeholders to clarify concerns, test proposals and refine Claims Rule drafts.
4. Translate complex clinical, data and policy considerations into clear materials for discussion.

4. Senior Management Submissions and Policy Papers

1. Prepare senior management submissions setting out the rationale, evidence, risks and implementation considerations for proposed Claims Rules.
2. Apply systems thinking to anticipate operational impact, provider behaviour, patient implications and unintended consequences.
3. Work collaboratively with stakeholders to incorporate inputs and prepare final drafts for approval.
4. Present recommendations clearly and concisely to support decision-making.

5. Implementation, Education and Review

1. Support the publication and communication of finalised Claims Rules.
2. Respond to implementation feedback and help clarify Claims Rule intent where required.
3. Support offline and online education efforts to enhance awareness and understanding of Claims Rules.
4. Contribute to periodic review and refinement of Claims Rules based on feedback, claims data and changes in clinical practice.

JOB REQUIREMENTS

Education and Professional Background

A basic university degree is required. The following backgrounds would be advantageous:

1. Medical degree, pharmacy degree, life sciences degree, health economics degree or related healthcare qualification.
2. Medical doctors, pharmacists or healthcare professionals familiar with clinical procedures, clinical guidelines or healthcare operations.
3. Candidates with research, policy, health financing, insurance, health technology assessment or pharmacoeconomics experience.
4. Candidates with experience analysing healthcare, claims, administrative, operational or financial datasets.

Technical and Analytical Skills

The candidate should demonstrate:

1. Strong analytical and critical thinking.
2. Ability to interpret clinical literature and synthesise evidence.
3. Ability to work with data to identify trends, risks and implementation considerations.
4. Familiarity with statistical or analytical tools such as Excel, SQL, Python, R, Power BI or Tableau would be advantageous.
5. Ability to distinguish between data signals, clinical evidence, stakeholder opinion and policy judgement.

Communication and Stakeholder Skills

The candidate should demonstrate:

1. Clear and precise written communication.
2. Ability to explain complex clinical, claims or policy issues to both clinical and non-clinical audiences.
3. Confidence engaging stakeholders with differing views.
4. Ability to identify areas of consensus and disagreement.
5. Ability to incorporate feedback while maintaining policy clarity and analytical rigour.

Other Required Qualities

We are looking for candidates who demonstrate:

1. Systems thinking, including awareness of implementation risks and unintended consequences.
2. Sound judgement when working with incomplete information.
3. Strong project management and follow-through.
4. Ability to manage timelines, stakeholder inputs and iterative drafting.
5. Openness to feedback and comfort working to high standards of accuracy and clarity.
6. Intellectual curiosity and willingness to learn unfamiliar clinical or policy areas.

A successful officer in this role will be able to move from evidence and data to a balanced recommendation, explain trade-offs clearly, engage stakeholders constructively, and produce policy papers that are accurate, concise and implementation-oriented.

Shortlisted candidates may be asked to complete a written case exercise assessing evidence synthesis, claims-data interpretation, policy judgement, systems thinking and written communication.

Note: The appointed candidate will be seconded to Ministry of Health. The job title, such as Executive, Senior Executive or Manager, will also be determined based on the candidate’s qualifications and relevant experience.