Senior Manager Health Performance Management
prudential · Kuala Lumpur (Takaful) ·
- Seniority
- Senior
- Employment
- Part time
- Category
- Management
prudential · Kuala Lumpur (Takaful) ·
Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.
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
Data digitization:
Heathhives
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
Requirement
1. Degree in Analytical areas; Data Science, Actuarial, Engineering, Statistics etc
2. Knowledge in any of the following tools or programming language; Python, SQL, Excel, SAS
3.Experience in PowerBI or relevant tools.
4. Experience in Machine Learning or Predictive Modelling projects could be an added advantage
Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.