Assistant Manager

1 week ago

Huai Khwang, Bangkok, Thailand Krungthai AXA Life Insurance Public Company Limited Full time

Responsibilities:

  • Technical Auditor's Assistant Manager responsibilities on internal/external medical retrospective or audit. In term of claim, are deliver on Close File Review such as utilizing CPT, ICD-9, ICD-10 and other coding system in medical standard billing process that depend on medical standard guideline and Policy contract.
  • Handling claim coverage payment, conducting quality assurance assessment and reviewing in Network Provider who provide medical treatment that focus on standard medical utilization.
  • Involving in part of Underwriting are audit in application or policies that issue from Underwriting department by compliance in early claim.
  • Summary performance report on in appropriate, leakage and recommendation for improvement.
  • Maintaining medical quality, quantity, and turn-time standards.
  • Deliver for auditing of Health claim, Close File Review to ensure appropriate selection of evaluation Deliver for auditing on Health application or Policy that issue by Underwriting.
  • Deliver for auditing of Medical Examination Report
  • Prepare resulting audit report by area responsible.
  • Responsible for conducting Internal/External retrospective review with Network provider and preparing report to feedback with Network Provider and monitoring for their improvement.
  • Set up plan for medical training program for Health team, ensuring on Clinical Practice Guideline
  • Provide audit performance monthly report by area responsible to line manager for opportunity for improvement, for best practice that could be applied in area, for preventive action, and outstanding emphasis on customer satisfaction.
  • Provide health claim performance report to department and set up medical training for closing the gap and development by individual or area Encourage to health team to reduce the gap area.
  • Monitor for the gap improvement.
  • Involve to process improvement project and other assignments from managers to deliver audit results as expected within the timeline.
  • Involve work processes to comply with internal control and standard, laws, regulations, or relevant agreement, as well as monitor, adjust policy, procedures, and work instruction in a current version.

Qualifications:

  • Bachelor of Nursing Science, Medical Technology or Healthcare related fields
  • At least 3-5 years' experience in Health Insurance, Health Claim Operations or Claim Quality Assurance
  • Experience in UR Nurse or Retrospective Investigation would be advantage
  • Proven relevant experience in project management.
  • Understanding of quality management and quality assurance
  • Understanding with healthcare services and operational process
  • Able to travel to upcountry for Hospital Audit

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