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.