Provider Business Partnering, Specialist

4 weeks ago

Kuala Lumpur, Malaysia AIA Full time

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.
- It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030._
- And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business._

Sound like you? Then read on.

About the Role

The position is responsible to handle and grow a panel of specialist who provide medical services with cashless facility to covered members and policyholders of AIA health insurance policies. It is also aim to build cordial business relationship with the health specialists and ensure medical claims costs are contained optimally with regular performance dialogues and monitoring of utilization with the use of analytics.

Roles And Responsibilities

1. Network Specialist Management

(a) Specialist Panel-ship- Provide relevant assessment criteria and recommendations based on credentialing guidelines and requirements.- Support the process of deliberation.

(b) Provider Engagement- Build Performance Dialogues presentation deck from internal dashboards.- Provide and receive feedback from providers by observing behavior and evaluating the performance of specialist based on claims utilization, market benchmark, service level, adherence to fee schedule and possible fraud for mutual improvement.

(c) Provider Contracting- Support vendor deliberation and contract signing to gain strong commercial improvements and delivery of major cost savings.- Ensure contracts are renewed before expiry and continuously follow up to ensure contracts are closed within a reasonable time period.

(d) Relationship Management & Communication- Regularly monitor and communicate to panel specialist on the required parameters to remain within the network of AIA Health Services.

2. Health Analytics- Provide actionable insights from the relevant dashboards related to specialist/providers and medical inflation for the empanelment of specialists.- Provide analysis and tracking of medical inflation and claims savings from: renegotiations of discounts, specialist, and new parameters for tracking.- Perform quarterly bill reviews of top incurred specialists and identifying major cost contributors in the bill.- Perform bill reviews as needed to support Performance Dialogues, empanelment and daily operational needs.- Perform due diligence using analytics.

3. Cost Management- Support the Team’s Managers in driving the Network Strategy to achieve targeted medical inflation targets.- Improve cost savings opportunities.- Support special projects that may incur significant savings and impact on medical inflation.

Minimum Job Requirements

Education: Tertiary qualification in Medicine or relevant field of study.

Work experience: At least 5-8 years of related working experience in healthcare, managed care or insurance industry.

General Requirements: Knowledge in healthcare management, experience in nursing and medical advancement. Good verbal and written communication skills, problem solving skills, able to handle people, fundamental knowledge in accounting principles, good analytical skills, proficiency in basic computer operating software like MS Office, and willing to travel for job assignments.
- Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives._

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