Job Description
Job Description: Concurrent review and utilization management Daily perform concurrent review of patient’s clinical information from hospital network to ensure appropriateness of care are in accordance with policy terms and conditions
Reviewing patients’ medical records to identify errors or missed diagnoses that could have been detected earlier in treatment or unnecessary investigation and treatment
Coordinates patient’s discharge planning with UR or UM physician for ongoing case to ensure appropriate length of stay
Analyze a situation and able to make decision based on the receive information whether a patient is ready to be discharged from the hospital
Seek consultation from appropriate disciplines/departments as required to expedite claim decision and facilitate timely and accurate communication of claim decision and clinical reviews before discharge
Refer case issues to team advisor(s) in a timely manner and monitor the issue until it is resolved
Prepare monthly the Utilization Management and cost savings report in area responsibility
Keep close monitoring claim TAT to ensure all cases could be completed within SLA
Deliver service with a strong focus on customer satisfactions
Build strong relationship with hospital to contribute the smoothly cashless claim journey
Support peers in the aspect of holistic health claim management
Ensure the correctness of claim data capturing
Assist in manage team daily performance Process improvement Develop trusted relationships with involved parties – listen actively to their concerns and questions to better understand their requests and perspectives
Participate in the overall improvement efforts of the Project Management team by seeking opportunities for feedback and development
Revisit the current process and define the improvement then identify quick win solution
Quality and cost efficiency controls Supporting internal control tools and internal audit program for team to determine the appropriate claim authority and performance evaluation aspect
Help develop work instruction, guideline for hospitals and claim SOP to increase effective resolution of all claim inquiries
Establish the process of checks and balances
Provides the stakeholder the feedback that related to their performance such as early claim case
Assist in develop SOP, Workflow and procedure and effectively communicate to team
Timely report the significant incident with immediately action, short term solution and preventive action
Timely provide regular and ad hoc report
People development Develop multiple skills that will support team and company goal
Report and solve the problem and regular feedback with team
Monitor and encourage team to participate self-learning
Assist in providing training to the other concerned parties such as CCC, distributors
Qualifications: Bachelor's degree in nursing At least 2-3 years of experience in UR Nurse or Nurse ward/ICU in hospital At least 1 year of working experience in Life or non-Life Insurance and Health Claims is preferred Previous training and demonstrated competence in negotiation, quality assurance, case management outcome Capable to communicate in both writing and speaking English Negotiate and handle issues with external and internal parties About Krungthai-AXA Life Insurance Krungthai-AXA Life Insurance Public Company Limited, created from a solid co-investment partnership between Krungthai Bank PCL. and the AXA Group, global financial protection and asset-management specialists
The trademark of Krungthai-AXA Life Insurance is designed to indicate the combination of the two corporations
Krung Thai Bank PCL. and AXA Group logos are aligned with Thai characters displaying the company name as Krungthai-AXA Life Insurance placed above the red line and the new company signature
Redefining/Life Insurance
Today Krungthai-AXA Life Insurance Public Company Limited is a fast-growing life insurance company with a vision – Ambition AXA
Our Perks and benefits Employee and Family Health Insurance Benefits Life and Accident Insurance Benefits Hybrid Working and Flexible Working Hours Annual Leave & Birthday Leave Salary Increment & Bonus Digital Learning - Self Learning Organization Annual Health Check up Provident Fund