Role:                                 

The individual is responsible for providing clinical expertise and support to the health insurance business.

This role requires a deep understanding of musculoskeletal (MSK) conditions, treatment options, the

healthcare landscape in Asia, and ideally, another region (Europe, Middle East, Americas). The Consultant

will work closely with clinical, network, claims, advocacy, marketing, and product development teams

ensure the company’s medical policies align with best practices and industry standards.

Reports To:               

Associate Medical Director, APAC

Responsibilities:

Strategy:Contribute to the strategic direction and operational policies in the management of MSK rehabilitation.Clinical Expertise:Provide medical expertise on musculoskeletal conditions, treatments, and technologies.Stay updated on the latest advancements in MSK healthcare.Develop and maintain clinical guidelines and protocols for musculoskeletal claims.Provide subject matter expertise for other business divisions including Network, Payment Integrity, Marketing and Sales and Client Management.Utilization Management:Provide clinical review and assessment of MSK claims and pre-authorizations.Identify potential fraud, abuse, or unnecessary medical services.Develop claim and pre-authorization management guidelines for MSK conditions.Peer to peer discussions with medical professionals/physiotherapists.Member outreach and support for complex MSK cases and assist with navigating their MSK conditions.Product Development:Provide clinical input into the development of new MSK health insurance products.Develop product features and benefits to address the specific needs of the musculoskeletal population.Provider Network Management:Evaluate the quality and cost-effectiveness of MSK healthcare providers (HCPs).Develop and maintain relationships with key MSK HPCs globally to improve customer experience and optimize cost containment efforts.  Participate in provider network development and management activities.Regulatory Compliance:Ensure compliance with all relevant healthcare regulations and industry standards.Stay updated on regulatory changes and their impact on the MSK healthcare landscape.Education and Training:Conduct training sessions for internal staff, clients, members, and other relevant stakeholders on MSK health topics.Develop educational materials for customers and healthcare providers.Participate in industry conferences and seminars.

Professional Requirements:

Essential

Master’s degree in Physiotherapy.Active practicing license with the local regulatory body.Minimum 8 years of frontline clinical experience with good knowledge of medical procedures and treatments rendered in MSK related conditions.Strong clinical judgment and decision-making skills.Proficiency in Microsoft Office, CRM, and database applications.Strong understanding of insurance principles and risk management.Fluent in written and oral English.

Desirable

Prior experience in the following areas of:Case ManagementUtilization ReviewAbility to interpret data and translate findings into business opportunitiesAbility to develop relationships across all levels of the Company, as well as externally. Experience working in a culturally diverse environment with a global team.Additional language capabilities.Experience in the health insurance industry.Knowledge of healthcare economics and cost-benefit analysis.

Personal Competencies:

Strong interpersonal communication skills.Data analytical skills.Research and evidence appraisal skills.Ability to succeed in a highly matrix environment with competing priorities.Ability to work independently and self-motivated.Growth mindset.Results driven, quick learner, and ability to establish creditability with varied audiences.

About The Cigna Group

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.