Job Summary:

The position holder is responsible to ensure providers are providing the best possible treatment for Allianz and price guidelines with high levels of quality based clinical outcomes

Key Responsibilities:

Clinical Quality

• Develop and implement a clinical quality strategy, which assures our members that they are receiving high quality and appropriate care.
• Ensure that all treatment and care given to our members including admission to hospital is appropriate and in accordance with agreed protocols.
• Encourage clinical best practice by providing analytical feedback hospitals, clinics and doctors on clinical practice including procedural costs, length of stays and outcomes.
• Ensure that all hospitals and clinics in our network meet our standards of care and take necessary action when the care given is below standard.
• Ensure that any new clinical procedures, drugs or technology are appropriate and safe for our customers
• To review and manage the treatment of high claiming members to ensure that their treatment is appropriate

Clinical Audit

• Carry out clinical audits on both provider network and non-provider network, ensuring that Allianz customer receive high quality and appropriate treatment and care at an affordable price.
• Retrospective review (Internal and External Audit).

Clinical Governance scheme

• Attend the pool insurance meeting as schedule Attend claim and clinical committee as team member

Must Have

• Bachelor’s or master’s degree in Nurse Science
• At Least 3-5 yrs of experience in Nurse in hospital and insurance industry experience will be advance
• Understanding of insurance databases
• Experience in data collection, evaluation, and interpretation
• Experience in data analysis and data visualization tools (e.g. PowerBI, Tableau)
• Knowledge of collaborative project management tools (e.g. Trello, JIRA, Asana)
• Knowledge of Microsoft Office suite, Microsoft EPM, and MS Outlook
• Any AI-future skills e.g., ChatGPT, or CoPilot365, will be advantage.