Monitor and track performance of Fraud, Waste and Abuse activities as part of claim containment agenda, such as non-coverable items, corporate discount, decline claim, hospital waste, doctor abuse, and contractual exclusion. Support team lead and provider management lead on Provider Network Management activities as follows:
Improvement on discount rate post negotiation with providers.
Support data preparation and provider network scorecard preparation, with collaboration of PAMB team.
Support ad-hoc request by Provider Network Management team ie: benefit of provider steerage, tariff rate
Support team lead and Health Ecosystem on other initiatives:
Support on analytics needs such as CBA, ACR preparation and materials for management support
Support during implementation and post implementation tracking of benefits.
Responsible for regulatory reporting:
MHIT quarterly submission
Ad-hoc request from regulators such as LIFTO
Support team lead in preparation of monthly reporting:
HBM – compile reports from operation team to tracks of claims containment benefits
Support on Group FWA reporting on the claims benefits tracking
Other reporting MBR and QBPR
Support team lead and Claim Operation on data requests and analysis
Ad-hoc request such as claim appeal analysis
Automation of report, such as NCI assessor scorecard, R&C benchmark, and Robotic procedure benchmark
Provide and cross collaboration analytics works with Sales Enablement, Agency and Product Marketing