Claims Rules Analyst – MediShield Life Claims Management Office

The Claims Management Office (CMO) in the Healthcare Finance Group of MOH ensures appropriate care through development of claims guidelines and claims adjudication. Reporting to the Team Lead of the Claims Management Office, the Claim Rules Analyst develops and promulgates MediShield Life Claims Rules. The officer will perform analysis on past claims data to identify egregious claiming patterns and to monitor the effectiveness of claims guidance over time following implementation. You will be working in a fast-paced and dynamic environment that would require the ability to manage multiple priorities and stakeholders at the same time.

1.Perform clinical literature review from international guidelines and produce preliminary draft of claims rules • 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 • Review published medical literature and journals for cost and clinical effective treatment option • Draft the Claims Rules based on research of guidelines and literature in consultation with clinician/experts workgroups and internal MOH staff 2.Data analysis on claims • To identify egregious claim patterns and apply insight for claims rules development • To assess feasibility of implementation of claim rules using historical claims data • To quantify potential cost-savings through claim rules 3.Conduct stakeholder consultations • To provide secretariat support during Claims Rules Workgroup discussions • To illicit key points of discussion and engage stakeholders for consultation to arrive at a consensus • Collate inquiry and inputs from respective stakeholders to be incorporated into the claims rules draft 4.Produce senior management policy papers rationalising Claims Rules • Apply systems thinking in producing policy papers • Work collaboratively with various stakeholders in incorporating inputs for drafts • Seek senior management approval on the final draft of claims rules and other related submissions 5.Engagement and education of stakeholders in understanding final promulgated Claims Rules • Publish claims rules and respond to feedback during implementation • Drive offline and online education efforts to enhance awareness and understanding of claims rules

Key Competencies Required: • Thinking Clearly & Making Sound Judgements – Strong analytical and critical thinking abilities to support the crafting of sound policy recommendations; ability to grasp timelines, operating context and ground realities. • Learning & Putting Skills into Action - Possesses the drive and curiosity to learn and apply new skills, knowledge and new ways of working. • Improving & Innovating – Ability to seek continual improvements, and to innovate and experiment while managing the risks involved. • Working Effectively with Stakeholders – Ability to mobilise and rally partners and stakeholders towards a collective purpose. • Basic University Science Degree, highly advantageous if candidate is a healthcare professional (MBBS or equivalent, Pharmacy degree, or Life Sciences PHD) or health economist • 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 • 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 • Perspective gathering, 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 As part of the shortlisting process for this role, candidates may be required to complete a medical declaration and/or undergo further assessment.