Job Purpose: The Medical Assessor will provide functional expertise on cases ensuring that medical decisions adhere to Cigna’s global clinical guidelines. He/she will manage pre-authorization services to ensure cost-effectiveness and appropriateness of treatment, with the goals of generating cost savings and improving health outcomes. The Medical Assessor will partner with other business divisions such as Sales and Client Management, by applying medical knowledge to support the business needs.
Critical Tasks and Expected Contributions/Results:
- Manage the pre-authorisation process for cases in Singapore, assessing proposed treatment and therapies for medical necessity, in accordance with global medical guidelines.
- Review claims and evaluate the appropriateness and cost-effectiveness of the medical treatment and services.
- Completes day-to-day Case Management tasks without immediate supervision, but has ready access to advice from more experienced team members.
- Use clinical knowledge to assess diagnosis and treatment plans and goals, and identifies gaps in care or risks for readmission or complications.
- Establish patient centric goals and interventions to meet the member’s needs.
- Coordinate care and interface with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners.
- Balance business needs with patient advocacy.
Key Challenges/Anticipated Changes in Environment:
- Demonstrate sensitivity to emotionally distressed and culturally diverse situations, clients and customers.
- Manage/coordinate an active volume of cases by providing information and coordination to customers worldwide in a multicultural population.
- Coordinate care with other Cigna Case Managers around the world when a need for local or regional expertise is important for better care or to comply with regulations.
Developmental Value of Position:
- Gain experiences and knowledge within the insurance and healthcare industry
- Broad exposure to all aspect of business operations and to develop leadership/general management skills
- Continue to utilize and enhance healthcare knowledge while out of clinical setting
Experience/Knowledge, Education and Other Requirements:
- Bachelor’s Degree in Medicine/Surgery or Masters and/or Advanced Practice Certification in Nursing
- Minimum 8 years clinical experience with broad knowledge of various medical discipline with a clear understanding of medical conditions and clinical procedures
- Prior experience in health insurance industry (specifically case management and utilization review) is a bonus
- Strong understanding of the healthcare system in Singapore
- Competency in analyzing clinical research and journals
- Ability to interpret data and translate findings into business opportunities
- Ability to develop relationships across all levels of the Company, as well as externally
- Fluent in written and oral English. Additional language capabilities is a bonus.
Personal Competencies Required:
- Strong interpersonal communication skills.
- Analytical and meticulous
- Good negotiation skills
- Ability to succeed in a highly matrix environment with competing priorities
- Ability to work independently and self-motivated
- Results driven, quick leaner and ability to establish creditability with varied audiencesStrong people management and leadership skills
