Claims Rules Analyst

About the organisation

MOH Holdings is the parent company for Singapore’s public healthcare institutions. The organisation is seeking people who want to contribute meaningfully to public healthcare and grow in a workplace that supports professional development, leadership capability, and skill-building.

Role summary

The Claims Rules Analyst reports to the Team Lead of the Claims Management Office and plays a key role in supporting appropriate care under Singapore’s national financing schemes. This position focuses on developing and communicating MediShield Life Claims Rules, while also reviewing historical claims data to spot unusual claiming behaviour and track how well claims guidance works after it has been put into practice.

Key responsibilities

You will work across research, analysis, stakeholder engagement, policy drafting, and education to shape and implement claims rules.

• Carry out literature reviews using international clinical guidelines and published medical research to prepare initial claims rule drafts.
• Study relevant overseas claims frameworks, including UK NICE guidance as well as Irish and Australian medical insurance claims rules, and review evidence on clinical and cost effectiveness.
• Assess medical journals and published research to identify treatment options that are clinically effective and cost effective.
• Prepare draft Claims Rules in consultation with clinician expert groups and internal MOH colleagues.
• Analyse claims data to detect unusual or problematic claiming trends that can inform claims rule development.
• Evaluate whether proposed claim rules can be implemented effectively using historical claims records.
• Estimate the possible cost savings arising from the introduction of claims rules.
• Support consultation sessions as the secretariat for Claims Rules Workgroup discussions.
• Capture discussion points accurately, engage stakeholders, and help build consensus during consultations.
• Compile questions, comments, and inputs from stakeholders and incorporate them into draft claims rules.
• Prepare policy papers for senior management that explain and justify the proposed claims rules.
• Use systems thinking to structure policy submissions and align inputs from different parties.
• Coordinate with multiple stakeholders to refine drafts and obtain senior management approval for the final claims rules and related submissions.
• Support the rollout of final claims rules by publishing them and responding to implementation feedback.
• Plan and deliver both online and offline education initiatives to improve understanding and awareness of claims rules.

Requirements

• A basic university science degree is required; a background in healthcare, such as MBBS or equivalent, pharmacy, life sciences PhD, or health economics, is a strong advantage.
• Medical doctors, pharmacists, and other healthcare professionals with knowledge of surgical procedures or research experience are preferred, as this helps with evidence review and workgroup discussions.
• Knowledge of health financing policy, pharmacoeconomics, and health technology assessment is an important plus.
• Experience in statistical analysis and familiarity with tools such as Python or Tableau will be beneficial.
• You should be able to understand different perspectives and synthesize viewpoints effectively.
• Strong analytical ability and sound critical thinking are needed.
• You must be comfortable working with internal and external stakeholders in a collaborative manner.
• Good verbal and written communication skills are essential.
• Prior project management experience is helpful, especially in assigning responsibilities, coordinating inputs and clarifications, tracking timelines and progress, and handling clinical or medical projects.
• The final level of appointment, whether Executive, Senior Executive, or Manager, will depend on your qualifications and relevant experience.

Additional information

This is a full-time onsite position based in Singapore. The role supports the continued development, communication, and implementation of claims rules that guide appropriate care within Singapore’s public healthcare financing framework.