Senior Manager Health Performance Management

We are seeking a Senior Manager for Health Performance Management at Prudential. As a Senior Manager, you will play a key role in monitoring and tracking performance of Fraud, Waste and Abuse activities as part of claim containment agenda.

Responsibilities:

• Monitor and track performance of Fraud, Waste and Abuse activities
• Support team lead and provider management lead on Provider Network Management activities
• Support data preparation and provider network scorecard preparation
• Support ad-hoc request by Provider Network Management team
• Support team lead and Health Ecosystem on other initiatives
• Responsible for regulatory reporting
• Support team lead in preparation of monthly reporting
• Support on Group FWA reporting on the claims benefits tracking
• Other reporting MBR and QBPR
• Support team lead and Claim Operation on data requests and analysis
• Ad-hoc request such as claim appeal analysis
• Data digitization: Heathhives
• Automation of report, such as NCI assessor scorecard, R&C benchmark, and Robotic procedure benchmark
• Provide and cross collaboration analytics works with Sales Enablement, Agency and Product Marketing

Requirements:

• Degree in Analytical areas; Data Science, Actuarial, Engineering, Statistics etc
• Knowledge in any of the following tools or programming language; Python, SQL, Excel, SAS
• Experience in PowerBI or relevant tools
• Experience in Machine Learning or Predictive Modelling projects could be an added advantage