Healthcare Network Management Executive

7 days ago


Kuala Lumpur, Kuala Lumpur, Malaysia GREAT EASTERN Full time

GREAT EASTERN is a leading insurance company with a long-lasting legacy of trust built over many generations. Our foundation is based on Integrity, Initiative, and Involvement – from the way we treat every customer relationship with honesty and transparency to our proactive approach of delivering the best possible solutions in life and general insurance.

We are seeking a professional to join our team as a Healthcare Network Management Executive for the Healthcare Clinic Network Management team.

**Job Purpose:**

  • To lead the development and management of the panel clinic network by leveraging medical expertise to ensure quality and cost-effective healthcare services.
  • The role requires a deep understanding of primary care settings, medical cost structures, clinical best practices, and the ability to engage with healthcare providers on service quality, treatment protocols, and pricing strategies.

**Key Responsibilities:**

  • Lead the identification, onboarding, and management of panel clinics.
  • Develop and maintain strategic partnerships with clinic management and medical practitioners.
  • Support negotiations for service agreements, discounts, and other contractual arrangements with clinics.
  • Assess and negotiate service agreements with clinics, ensuring appropriate clinical care at cost-effective rates.
  • Monitor and analyze trends in primary care treatment costs, medical service utilization, and emerging healthcare practices.
  • Perform clinic profiling by evaluating clinic performance based on medical quality indicators, patient outcomes, and adherence to clinical guidelines.
  • Resolve complex grievances, disputes, and escalated issues with clinics, including medical treatment concerns, billing discrepancies, and service quality issues.
  • Collaborate with internal teams to assess medical cost drivers and develop cost-containment strategies.
  • Ensure that panel clinics comply with medical regulations, ethical standards, and Company policies.

**The Ideal Candidate:

  • Possesses either a Degree in Healthcare related field of studies. Majoring in Insurance would be an added advantage.
  • Minimum of 3 years of experience in clinical practice, healthcare management, or medical insurance operations.
  • A licensed medical doctor in good standing within the medical community is preferred.
  • Strong understanding of primary care clinical settings, medical cost structures, and treatment protocols.
  • Proven experience in engaging with healthcare providers, including general practitioners and specialists.
  • Demonstrated ability in negotiation and stakeholder management, particularly in medical service agreements and cost-containment initiatives.
  • Strong analytical and problem-solving skills, particularly related to medical billing, claims, and grievance resolution.
  • In-depth knowledge of healthcare regulations, medical ethics, and industry practices.
  • High level of integrity, takes accountability of work and good attitude over teamwork.


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