Claims Rules Analyst

ORGANISATIONAL INFORMATIONAs 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 OVERVIEWReporting 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 RESPONSIBILITIESPerform clinical literature review from international guidelines and produce preliminary draft of claims rulesResearch 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 effectivenessReview published medical literature and journals for cost and clinical effective treatment optionDraft the Claims Rules based on research of guidelines and literature in consultation with clinician/experts workgroups and internal MOH staffData analysis on claimsTo identify egregious claim patterns and apply insight for claims rules developmentTo assess feasibility of implementation of claim rules using historical claims dataTo quantify potential cost-savings through claim rulesConduct stakeholder consultationsTo provide secretariat support during Claims Rules Workgroup discussionsTo illicit key points of discussion and engage stakeholders for consultation to arrive at a consensusCollate inquiry and inputs from respective stakeholders to be incorporated into the claims rules draftProduce senior management policy papers rationalising Claims RulesApply systems thinking in producing senior management policy papersWork collaboratively with various stakeholders in incorporating inputs for draftsSeek senior management approval on the final draft of claims rules and other related submissionsEngagement and education of stakeholders in understanding final promulgated Claims RulesPublish claims rules and respond to feedback during implementationDrive offline and online education efforts to enhance awareness and understanding of claims rulesJOB REQUIREMENTSEducation 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 economistMedical doctors, pharmacists or healthcare professionals familiar with surgical procedures and/or with research background is preferred to critically appraise evidence and support clinical workgroup discussionsUnderstanding of Health Finance Policy, Pharmacoeconomics and Health Technology Assessment principles is a significant advantageExperience in statistical analysis with demonstrated competency in using statistical tools such as Python or Tableau will be advantageousOther requirements / qualities:Perspective gatheringAnalytical and critical thinkingAble to collaborate and work with internal and external stakeholdersEffective oral and written communicationProject 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 projectsThe appointed job title (Executive / Senior Executive / Manager) will be determined based on the candidate’s qualifications and relevant experience.