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Medical Cost Containment Specialist
2 weeks ago
About the Opportunity
AIA Hong Kong and Macau is a leading life insurance company committed to helping our customers live Healthier, Longer, Better Lives. We are seeking a detail-oriented Medical Cost Containment Specialist to join our team in Kuala Lumpur.
About the Role
This is a challenging and rewarding opportunity for a skilled professional who is passionate about healthcare management and cost containment. You will work closely with our specialist doctors, medical directors, and panel providers to ensure medical claims costs are contained effectively through regular performance dialogues, scorecard management, and monitoring of utilization with the use of analytics.
Key Responsibilities
- Specialist Management: Manage and grow a network of specialist doctors who provide cashless and cost-efficient service to covered members, including recruitment, utilization management, and termination.
- Provider Engagement: Create an engagement platform with medical directors, hospital management, and specialists to highlight cost and behavior of specialists, and improve overall performance.
- Scorecard Management and Review: Monitor specialist doctor's scorecard to track specialist cost, engage with medical directors and specialists to explain and understand scorecards, and decide on specialist removal or continued watchlist status.
- Cost Management: Participate in executing Specialist Management Strategy to achieve targeted medical inflation targets, maximize cost savings on specialist cost management, and support special projects that may incur significant savings and impact on medical inflation.
