Careers

Role Description

• Accountable in a quality improvement process for an effective and efficient healthcare system and healthcare delivery.

Responsibilities

1. Managing complex cases, working with the team to define a variety of clinical needs for our customers, they will assess, plan, implement and evaluate evidence-based, person-centered care.
2. Review medical documentation and records for potential fraud, waste, abuse, or malpractice and identify trends in health care provider behavior and billing patterns.
3. Perform continuous evaluation of the audit program and recommend specific standards to be utilized in the audit process.
4. Analyze existing clinical audit practices and policies to define and ultimately implement changes to improve clinical integrity and overall hospital processes.
5. Analyze clinical risk information and alert the management team with rising trends and hotspots, suggesting viable options for reduction and/or correction.
6. Provide guidance and support to the medical team regarding the implementation of policies& procedures and ensure effective systems for evaluation are developed.
7. Working together with the Standard, Quality, and Accreditation Department (SQA) to develop criteria for the accreditation of providers.
8. Performs all other duties as assigned.

Requirements

1. A Bachelor’s degree preferably in medicine, pharmacy, or audit-related field.
2. Preference with a minimum of 3 years of working experience in the Takaful / Insurance / TPCA / Healthcare industry.
3. Detail orientated and have good attention to accuracy to identify outliers and inefficiencies.
4. Good written and verbal communication skills
5. Willingness to work creatively and collaboratively in an interdisciplinary environment.
6. Organised and self-motivated.
7. Ability to manage multiple tasks and meet the demands of a fast-paced environment with changing priorities.

Role Description

• Medical Auditor will be responsible for assisting with/conducting audits of medical records, procedures, and any related medical activities to ensure quality and compliance with the standard set.

Responsibilities

1. Support and assist in clinical audit to ensure the services given follow the latest guideline and SOP set.
2. To carry out the post-pay audit and medical audit for a specific disease to compare the differences in claim, treatment, and outcome.
3. Working together with the Standard, Quality, and Accreditation Department (SQA) to develop criteria for the accreditation of providers.
4. Identify triggers based on the quality and appropriateness of health care services provided and not just financial triggers.
5. Ensure the claim submission system will include the variable/entry that shows how the treatment/management had followed the CPG.
6. To run of post-pay audit of selected disease/treatment, any outlier claims, or random sampling.
7. Present the finding to the management committee/CEO and the proposal on how to make it better
8. To ensure the new core system/ claim system of the Company will have the variable/entry
9. Carry out a site visit to monitor/help/educate for better claim and treatment submission can be achieved.
10. Performs other related duties as required and assigned.

Requirements

1. A Bachelor’s degree preferably in medicine, pharmacy, or audit-related field.
2. Preference with a minimum of 3 years of working experience in the Takaful / Insurance / TPCA / Healthcare industry.
3. Willingness to work creatively and collaboratively in an interdisciplinary environment.
4. Detail orientated and have good attention to accuracy to identify outliers and inefficiencies.
5. Organised and self-motivated.
6. Ability to manage multiple tasks and meet the demands of a fast-paced environment with changing priorities.
7. Basic in Python Language is advantageous.

Role Description

• Accountable in a quality improvement process for an effective and efficient healthcare system and healthcare delivery.

Responsibilities

1. Support and assist in clinical audit to ensure the treatment follow the latest Clinical Practice Guideline (CPG) provided by the Ministry of Health.
2. To carry out the post-pay audit and medical audit for a specific disease to compare the differences in claim, treatment, and outcome.
3. Working together with the Standard, Quality, and Accreditation Department (SQA) to develop criteria for the accreditation of providers.
4. Developing the visiting team that will involve SQA and other relevant departments of the Company.
5. Identify triggers based on the quality and appropriateness of health care services provided and not just financial triggers.
6. Ensure the claim submission system will include the variable/entry that shows how the treatment/management had followed the CPG.
7. To run of post-pay audit of selected disease/treatment, any outlier claims, or random sampling.
8. Present the finding to the management committee/CEO and the proposal on how to make it better.
9. To ensure the new core system/ claim system of the Company will have the variable/entry.
10. Carry out a site visit to monitor / help / educate for better claim and treatment submission can be achieved.

Requirements

1. A Bachelor’s degree preferably in medicine, pharmacy, or audit-related field. 
2. Preference with a minimum of 3 years of working experience in the Takaful / Insurance / TPCA / Healthcare industry.
3. Willingness to work creatively and collaboratively in an interdisciplinary environment.
4. Organised and self-motivated.
5. Ability to manage multiple tasks and meet the demands of a fast-paced environment with changing priorities.

Role Description

• This position is responsible to formulate and monitor the Corporate Scorecard and Key Performance Indicators (KPIs) in achieving the Company’s strategic objectives in positioning ProtectHealth as the Premier Not-for-Profit Healthcare Financing Service Provider. In addition, the incumbent will facilitate research, content management as well as compilation of presentations and reports.

Responsibilities

1. Ensure suitable metrics and Corporate KPIs are in place to measure performance and progress of the Company.
2. Responsible for monitoring and tracking of the Company’s scorecard and KPIs on the monthly tracker.
3. Be a business partner with the various departments and guide teams in identifying any gaps to achieve the KPIs.
4. Scan and research the business environment and healthcare industry for:
   i) content management to be used for internal and external presentations and reports
   ii) business opportunities to strategically position the Company (e.g. awards, speaking opportunities etc).
5. Responsible for compiling the Department’s monthly reports.
6. Facilitate the drafting of the Department’s policies, procedures and guidelines.
7. Support the Corporate Communications Department in any other deliverables.
8. Any other assignments or tasks as required by the Head of Department.

Requirements

1. A minimum of a Bachelor’s degree in Corporate Planning, Business Management or equivalent field.
2. Possess a minimum of 3 years’ experience working in Corporate/business planning and corporate communications.
3. Proficient in verbal and written communication skills in both English and Bahasa.
4. Sound knowledge of the healthcare industry.
5. Analytical and ability to multitask.
6. Articulate, professional and able to communicate in a clear, positive manner with internal and external stakeholders.
7. Experience with hands-on engagement, strong interpersonal/influencing skills.
8. Extremely detail-oriented and results driven to consistently meet deadlines.
9. Able to organize thoughts and make decisions under tight constraints.