Total 46 finance banking insurance job vacancies in Health / Beauty / Fitness category in Malaysia

• Plans work to be accomplished by subordinates, sets, and adjusts short term priorities, and prepares schedules for completion of work.
• Assigns work to subordinates based on priorities, selective consideration of the difficulty and requirements of assignments, and the capabilities of employees.
• Oversees the planning, organizing, directing, coordinating, and controlling the resources required to ensure the timely, accurate, and cost-effective accomplishment of Agency priorities.
• Leads the economic impact on small businesses, costs, savings, and effectiveness of draft regulations as required by RFA, the Small Business Regulatory Enforcement and Fairness Act and other relevant acts and Executive Orders.

• Direct the work of Health Insurance Specialists and contractor staff. Plans work to be accomplished by subordinates, establishes long and short-term priorities, and prepares schedules for completion of work.
• Formulate short and long-range DIMO-related plans, goals, and objectives, identifying resources needed to achieve optimum results.
• Collaborate with federal agencies, clinical and analytical experts, and healthcare management (e.g., providers, payers, states, businesses, community agencies, etc.) to assist in assessing the impact of new innovation models.
• Manage Health Insurance Specialists supporting model participants, monitoring program participants for compliance, and fostering learning and collaboration as points of contact for participants, providers, and other stakeholders.
• Directs the analysis of new or proposed program policy, regulations, or legislation impacting assigned areas of plan operations in coordination with CMS Headquarters.

• Direct and coordinate division activities relating to the provision of plan technical assistance and oversight of Medicare Parts C and D, or MMP drug and health plans assigned to the Division.
• Provide authoritative direction, guidance, and technical assistance to all types of drug and health plans assigned to the Division, implementing CMS policies and instructions.
• Collaborate and demonstrate teamwork working with other Divisions operating in the Group, on cross-cutting program, operational, and staffing matters, to achieve program results.
• Oversee the implementation of corrective actions and make recommendations to the Group Director for enforcement actions.
• Set priorities, prepare schedules for completion of work, assign work based on priorities, give advice and provide counsel or instruction to employees on both work and administrative matters.

• Serve as a senior advisor to management and executive leadership on developing and implementing strategic plans in support of achieving the PI/PE and MR functional program objectives.
• Perform complex reviews, evaluations, and follow-up of key initiatives to assure that goals, objectives, and deadlines are met.
• Provide leadership on a variety of special assignments involving all aspects of the management of health care and/or health care financing programs and projects.
• Evaluate the effectiveness of existing policies and reviews new policy and legislative initiatives for potential impact on OPOLE and/or the Agency.
• Participate in and makes key authoritative contributions to top-level discussions and planning sessions on management program policy development.

• Designs, plans, and conducts data and/or research studies concerning the trends and impact of CMS programs.
• Conducts analysis of policy issues and topics, researches background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
• Works with other CMS staff and stakeholders, either as a member of a project team or as a project lead, to develop methods for innovative approaches to determining and assuring the reliability and validity of productivity and workload data.
• Responds to inquiries regarding program policies to a variety of internal and external stakeholders (e.g., beneficiaries, providers, and representatives of public and private organizations, congressional staff, and other government organizations).

• Develop, implement, and maintain operational requirements, including standard operating procedures, as well as databases to manage and analyze programmatic information such as routine and ad hoc report, deliverables, and programmatic documentation.
• Gather and analyze information, conduct various reviews and studies to assess ongoing operations, program vulnerabilities and initiating/ recommending improvements or appropriate action.
• Respond to inquiries regarding program oversight activities to a variety of internal and external stakeholders.
• Establish and maintain contacts and working relationships with both internal and external stakeholders required to plan and execute tasks.
• Respond to inquiries regarding program activities to a variety of internal and external stakeholders.

• Develop, implement, and maintain program oversight strategy and processes, maintain operational requirements, including standard operating procedures and processes for overseeing entities that provide health care and prescription drug services.
• Monitor entities processes to identify program vulnerabilities and ensure continuing compliance with Agency agreements/contracts and all statutory, regulatory and sub-regulatory requirements are met.
• Gather and analyze information, conduct various reviews and studies to assess ongoing operations, program vulnerabilities, and initiate/recommend improvements or appropriate action.
• Develop, evaluate, and refine regulations, manuals, program guidelines, program memoranda, policy letters and instructions to effectively communicate policy to Agency stakeholders regarding compliance, audit and oversight programs.

• Serve as an expert in the development, evaluation, and implementation of policies related to reviewing, analyzing, and evaluating proposed legislation, regulations and other administrative actions for CMS’ programs.
• Develop, recommend, and prepare legislative policies and proposals for consideration by senior policy officials for inclusion in the President’s budget and legislative agenda.
• Analyze internal policies, processes, and procedures to assure increased efficiency in operations and implement them to resolve problems and improve internal operations.
• Prepare all forms of written correspondence regarding Medicaid program issues to the public, Congressional staff, industry contacts, and State representatives.
• Evaluate and analyze the impact of new or revised changes to legislation before the Congress pertaining to any CMS program.

• Researches patient records to ensure the insurance billing is correct.
• Posts payments received from the insurance companies to appropriate computerized ledgers and subsidiary ledgers.
• Explains Third-Party Collection (TPC) program to patients and their insurance companies.
• Calls numerous insurance companies to verify insurance coverage, amount of coverage, existing rules and regulations pertaining to the patient's policy.
• Maintains suspense records on all claims and correspondence.

• Develops new techniques to research and prepare raw health insurance program data more efficiently and effectively within the Group/Division.
• Ensures research and analysis conducted are technical sound and conform to policies, directives, and studies.
• Develops and implements programs and techniques to improve data quality and business practices for the Group/Division.
• Identifies and explains disparities between reporting periods in regard to changes, trends, or circumstances not readily evident from the data.

• Perform data studies that identify complex trends and outlines the potential impact to CMS programs.
• Maintain various reports for data capture and data quality improvement activities relating to a wide range of source data collection and information systems.
• Review the legal background, legislative history, administrative case law, and court decisions that interpret the policies and regulations for the CMS programs.
• Develop programs and techniques to improve data quality and business practices for the Group and Division.

• The incumbent designs, plans, and conducts data and/or research studies concerning the trends and impact of CMS programs.
• Conducts analysis of policy issues and topics, researches background information, the origin of laws, and the intended impact in order to make effective policy recommendations.
• Works with other CMS staff and stakeholders, either as a member of a project team or as a project lead, to develop methods for innovative approaches to determining and assuring the reliability and validity of productivity and workload data.
• Responds to inquiries regarding program policies to a variety of internal and external stakeholders (e.g., beneficiaries, providers, and representatives of public and private organizations, congressional staff, and other government organizations).

• Lead tasks designed to develop, evaluate, and implement a wide range of program integrity initiatives and reviews to support CMS’ lines of business.
• Evaluate, develop, and implement improvements to program integrity to deter, reduce, and eliminate fraud, waste, and abuse.
• Review and comment on new or proposed policy revisions, regulations, administrative sanctions and legislation to determine their impact on contractor or provider operations, and the effect on safeguarding the Agency programs.
• Develop and review health care policies and legislation in order to draft related policy documents, regulations, procedures and guidance to states.
• Act as an Agency representative and contributes to discussions and planning sessions on program policy developments.

• Lead projects to develop and implement health insurance programs such as Medicare, CHIP, and private plans.
• Establish and maintain strong relationships with outside partners to ensure successful planning and execution of these projects.
• Develop operational requirements for overseeing health care and prescription drug services.
• Recommend improvement actions based on your assessments and monitor entities to ensure compliance with agency agreements and all relevant laws and regulations
• Collaborate with the CMS Office of Legislation and Congressional committees to conduct impact analyses or mark-ups of various legislative option

Job Description

• Provide accurate and timely assessment of medical claims within the required service standards and ensure that claims are paid accurately and promptly
• Handle claim investigation and claim appeals
• Review claims processes and participate in process improvement projects, initiatives and system enhancement for the department, including establish claims best practices
• Deliver excellent service and enhance customer and distribution channels relationship management
• Provide guidance to junior staff
• Any other ad-hoc duties as assigned by supervisor
• Take accountability in considering business and regulatory compliance risks and take appropriate steps to mitigate the risks
• Maintain awareness of industry trends on regulatory compliance, emerging threats and technologies in order to understand the risk and better safeguard the company
• Highlight any potential concerns/ risks and proactively share best risk management practices

Job Requirement

• Degree or Professional Insurance Certificate with at least 5 years of relevant shield claims experience
• Mid-level claims assessors who are looking for greater exposures
• Strong knowledge on integrated shield claim processes and industry initiatives in managing medical claim cost
• Customer-centric and meticulous with the ability to work under pressure
• Strong analytical, written and communication skills
• Excellent interpersonal skills to effectively communicate with all stakeholders
• Good medical knowledge and ability to explain medical conditions in insurance context
• Good business acumen with long term vision
• A team player
• High level of integrity, take accountability of work and good attitude over teamwork
• Take initiative to improve current state of things and adaptable to embrace new changes

Interested candidates who wish to apply for the advertised position, please click on “Apply”. We regret that only shortlisted candidates will be notified.

EA License No.: 01C4394 (PERSOLKELLY Singapore PTE LTD)

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