Healthcare Fraud Analyst

22 hours ago

Makati City, National Capital Region, Philippines Allianz PNB Life Insurance, Inc. (formerly PNB Life Insurance Inc.) Full time $50,000 - $100,000 per year

BENEFITS/PERKS

  • Competitive Salary

  • 13th and 14th month salary guaranteed

  • Performance Incentive Plan / Yearly Bonus

  • Retirement Program and Group Life Insurance

  • Hybrid Work Set-up after 6 months working on-site

  • Promotion opportunities

Job Overview

Working with the Global Claims Function, you will be responsible for the identification, investigation and remediation of Fraud, Waste & Abuse in claims submitted by Health Service Providers and our Health Customers.

You will represent the Global Claims Fraud Framework to our Collegues, Customers, and our Network of Health Service Providers.

You will also ensure that all Fraud, Waste & Abuse activities are captured & reported in accordance with the agreed reporting requirements.

Responsibilities

  • Identify & investigate fraudulent activities and present fraud reports to the relevant stakeholders

  • Participate in the role of Auditing in line with Operations Auditing Practices.

  • Review and assess regions, providers & other areas of risk to identify potential fraud or misrepresentation.

  • Identify & report cost containment opportunities

  • Identify Areas of fraud risk & assist with the design & implementation of controls to mitigate that risk.

  • Provide input into Operations Controls to achieve acceptable cost containment & fraud identification standards

  • Create & Facilitate Anti-Fraud Awareness & support material as required

  • Liaise with Global Operations Functions to ensure consistency in the application of the Global Claims Fraud Framework

  • Respond to client enquiries accurately and professionally and when necessary, liaise with additional departments to ensure an efficient response is given thereby achieving client satisfaction.

  • Other Ad Hoc tasks or projects in order to support the team and other areas of the business

Key Requirements

You must hold a Bachelors Degree in any medical field, Insurance or a related field, and be legally allowed to work in Philippines.

You must have at least 2 years experience in a customer focused environment , ideally in a clinical, paramedical, or health insurance role, and be knowledgeable in preparing data using Microsoft Excel or similar data tools.

You must have an excellent level of English (written, word, listening), and be comfortable with communicating at all levels of an Organisation in a professional manner.

To be successful in this position you will need to have the following skills/ experience:

  • Data Analytics Skills is required in this role

  • Experience in analysing and assessing medical claims of high values and complexities

  • Ability to communicate effectively with various audiences and all levels of the organisation

  • Proficiency in MS Office (in particular in Excel, Power BI, PowerPoint)

  • Excellent level of written and verbal English is essential.

  • Experience in problem solving & decision making

  • Can work onsite for the first 4 to 6 months, hybrid after

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