Claims Rules Analyst

Data analysis on claims

Produce senior management policy papers rationalising Claims Rules

Conduct stakeholder consultations

Reporting 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.

Engagement and education of stakeholders in understanding final promulgated Claims Rules

Perform clinical literature review from international guidelines and produce preliminary draft of claims rules

• To assess feasibility of implementation of claim rules using historical claims data
• Draft the Claims Rules based on research of guidelines and literature in consultation with clinician/experts workgroups and internal MOH staff
• Review published medical literature and journals for cost and clinical effective treatment option
• To illicit key points of discussion and engage stakeholders for consultation to arrive at a consensus
• To quantify potential cost-savings through claim rules
• Publish claims rules and respond to feedback during implementation
• To identify egregious claim patterns and apply insight for claims rules development
• Seek senior management approval on the final draft of claims rules and other related submissions
• To provide secretariat support during Claims Rules Workgroup discussions
• Collate inquiry and inputs from respective stakeholders to be incorporated into the claims rules draft
• Work collaboratively with various stakeholders in incorporating inputs for drafts
• Research 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 effectiveness
• Drive offline and online education efforts to enhance awareness and understanding of claims rules

• Analytical and critical thinking
• Understanding of Health Finance Policy, Pharmacoeconomics and Health Technology Assessment principles is a significant advantage
• Experience in statistical analysis with demonstrated competency in using statistical tools such as Python or Tableau will be advantageous
• Medical doctors, pharmacists or healthcare professionals familiar with surgical procedures and/or with research background is preferred to critically appraise evidence and support clinical workgroup discussions
• Basic University Science Degree, highly advantageous if candidate is a healthcare professional (MBBS or equivalent, Pharmacy degree, or Life Sciences PHD) or health economist
• Project 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 projects
• Able to collaborate and work with internal and external stakeholders
• Apply systems thinking in producing senior management policy papers
• Effective oral and written communication