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.
Position Objective:
- To manage and grow a panel of healthcare providers that provides medical services with cashless facility to covered members and policyholders of AIA health insurance policies.
- To build cordial business relationship with panel providers
- To ensure medical claims costs are contained effectively with regular performance dialogues and monitoring of utilization with the use of analytics.
- To support claims operations and act as intermediary for operational matters between panel providers and AIA Health Services.
Responsibilities
Network Management
Hospital Panel-ship;
- To provide the relevant assessment study on new panel provider applicant and provide recommendations based on credentialing guidelines, SOP and requirements.
- To support the process of deliberation by the Hospital Specialist Review Committee (HSRC) which includes documentation and site visits.
- To create the Performance Dialogues presentation deck from internal dashboards.
- To provide and receive feedback from providers by monitoring behavior and evaluating the performance of hospital panel provider based on claims utilization, market best practice, service level, adherence to fee schedule and possible fraud for mutual improvement.
- To support the negotiation of provider contract to gain strong commercial improvements and delivery of major cost savings.
- To be ensure necessary contracts are renewed before expiry, i.e. package pricing contracts and to continuously follow up to ensure contracts are closed within a reasonable time period.
- Relationship Management/Communication
- To oversee the handling of complaints from internal and external clients on services related issues by panel providers.
- To oversee and track swift resolution of claims and GL issues related to internal AHS processes thru active operations meeting and interventions.
- To conduct provider training sessions and proactively communicate with panel providers on new procedures and/or urgent updates to daily operational requirements of AHS
Business Development
- To build cordial win-win business relationships with providers.
- To coordinate business events with providers including meetings, official openings, launches, etc.
- To develop and disseminate marketing materials to promote package Preferred Providers.
- To develop and bridge the relationship between Agency and CSD with Preferred Providers.
- To follow up and close the Addendums for package pricing and terms renegotiations with providers.
Alliance Management
- To support the identification suitable providers to Platinum status.
- To support the identification suitable of package pricing partners
- To drive steerage to Platinum and package pricing partners
- To proactively manage the allocation and promotion of health events to preferred or package partners.
- Proactively create a calendar of events for each year either by matching to provider's calendar and/or populating an internal calendar.
Health Analytics
- To provide actionable insights from the relevant dashboards related to providers and medical inflation for the empanelment of providers.
- To provide analysis and tracking of medical inflation and claims savings from;
- Platinum providers
- Preferred Specialty Network
- Package Pricing
- Contract renegotiations of discounts
- To perform quarterly bill reviews of top incurred providers/diagnosis/procedures for identifying major cost contributors in the bill.
- To perform bill reviews as needed to support Performance Dialogues, empanelment and daily operational needs.
- To perform due diligence for package pricing using analytics.
Cost Management
- To support the team's managers in executing the Network Strategy to achieve targeted medical inflation targets.
- To maximize cost savings on panel negotiations
- To maximize the impact of package pricing by expanding to all viable procedures and hospitals nationwide.
- To support special projects that may incur significant savings and impact on medical inflation.
Minimum Job Requirements:
- Degree/Diploma in Business Administration, Health or Life Sciences, Allied Health or relevant disciplines
- Working experience in healthcare or managed care (TPA) or insurance industry.
- Knowledge in healthcare and provider network management, experience in nursing and medical advancement.
- Good verbal and written communication skills, negotiation skills, problem solving skills, able to manage people, good analytical skills, proficiency in basic computer operating software like MS Office, willing to travel for job assignments
