Asst. Manager Medical Advisor and TPA Management

• Asst. Manager Medical Advisor & TPA Management
• each day, you'll be…
• Monitor external TPAs to ensure they process approvals and claims quickly and follow company rules.
• Resolve billing disputes and issues between hospitals, TPAs, and the insurance company.
• Review medical billing trends to help minimize unnecessary claim costs.
• Stand as medical advisor role to solve any case management of complex high value cases.
• Gives recommendation on claim decision.
• Shows medical claim analysis for Statistical report purpose.
• Aggressive cost containment through tight adjudication.
• Partner with hospitals and clinics, negotiate tariffs/discounts, and handle contract renewals.

Requirements

• Must have Medical Doctor degree (MD).
• Have experience in Insurance, or Assistance Company related industry with minimum 3-4 years.
• Have experience in managing TPA and Provider Management.
• High analytical thinking and good communication skill.
• Computer skill: excel, Power point, Word.
• Well organized, able to work independently, and able to manage team.