Hospital Network Partnership, Consultant

2 days ago

Kuala Lumpur, Malaysia AIA Full time

FIND YOUR 'BETTER' AT AIA
- We don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us._
- We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives._

If you believe in better, we’d love to hear from you.

About the Role

The Network & Provider Management Specialist plays a key role in managing hospital panel partnerships, provider engagement, business development, and cost management initiatives. This role is responsible for ensuring quality healthcare provider networks, optimizing cost strategies, and driving patient steerage toward preferred providers

Roles & Responsibilities:
Panel Provider Panelship
- Support the Hospital Specialist Review Committee by coordinating documentation and site visits.

Provider Engagement
- Develop Performance Dialogue presentation decks using internal dashboards/ information to ensure providers are updated with AIA’s direction, change of processes and aligned with AIA goals.
- Monitor provider behaviour and evaluate hospital panel performance based on claims utilization, market best practices, service levels, fee schedule adherence, and fraud detection.
- Provide feedback and drive mutual improvement initiatives with providers.

Relationship Management & Communication:

- Oversee the handling of complaints from internal and external clients related to provider services, claims, and guarantee letter (GL) turnaround times (TATs) and service level agreements (SLAs).
- Track and ensure swift resolution of claims and GL issues through operations meetings and interventions.
- Conduct training sessions and communicate with panel providers on new procedures and operational updates.

Alliance Management
- Build strong, win-win business relationships with healthcare providers.
- Develop and distribute marketing materials to promote Preferred Providers and drive patient steerage.
- Strengthen collaboration between agencies, corporate clients, and Preferred Providers.
- Drive steerage initiatives to Preferred Providers.
- Manage the allocation and promotion of health events to Preferred Providers.

Cost Management
- Support the execution of the Network Strategy to achieve medical inflation targets.
- Support special projects that drive significant savings and improve medical cost management.

Minimum Job Requirements:

- Bachelor’s degree in healthcare management, business administration, or a related field.
- Minimum 5 years of experience in hospital operations, insurance, or healthcare industry.
- Preferred background: Medical doctor, nurse, or experienced professional in hospital billing, claims, or provider network management.
- Strong understanding of hospital billing practices, medical claims processes, and insurance fraud detection.
- Excellent interpersonal and negotiation skills to manage hospital relationships effectively.
- Strong problem-solving abilities and attention to detail.
- Effective communication and training capabilities.
- Ability to analyse medical and financial data to support cost containment initiatives.
- Proficiency in Microsoft Office and familiarity with hospital IT systems (e.g., HIS, e-claims platforms) is an advantage.
- Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives._

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