Job Description

About The Role To manage and grow a panel of specialist who provide medical services with cashless facility to covered members and policyholders of AIA health insurance policies. To build cordial business relationship with the health specialists and ensure medical claims costs are contained effectively 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 Create Performance Dialogues presentation deck from internal dashboards. Provide and receive feedback from providers by monitoring behavior and evaluating the performance of specialist based on claims utilization, market best practice, service level, adherence to fee schedule and possible fraud for mutual improvement. (c) Provider Contracting Support the negotiation and contract signing to gain strong commercial improvements and delivery of major cost savings. Ensure necessary contracts are renewed before expiry and continuously follow up to ensure contracts are closed within a reasonable time period. (d) Relationship Management & Communication Constantly 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 executing the Network Strategy to achieve targeted medical inflation targets. Maximize cost savings on specialists\' negotiations. Support special projects that may incur significant savings and impact on medical inflation. Minimum Job Requirements Degree in Medicine or relevant field of study. Working experience in healthcare, managed care or insurance industry. Knowledge in healthcare management, experience in nursing and medical advancement. Good verbal and written communication skills, problem solving skills, able to manage 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.

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