รายละเอียดงาน :
1. Develop and implement annual continued medical education program for HSM staff
2. Develop contents and conduct regular medical training for HSM staff (claims and medical management) including topics relevant medical claim assessment and medical management
3. Develop protocols and build, consolidate, improve medical management guidelines for current high volume admissions to support effective medical management decision
4. Develop standards and conduct medical record audit for medical services provided by network providers
5. Provide medical consultation to claim assessors and medical management staff including establishing panel of medical specialists to support the consultation
6. Provide medical opinions based on current standard of clinical practices for appeal or dispute medical claim decision upon request
7. Monitor health and illness situation that can impact medical service utilization
8. Be champion of HSM initiatives related to health and wellness promotion
9. Assist in the communication of medical issues with external stakeholders including doctors, hospitals, customers and agents as assigned
