Associate, Network Management

Great Eastern Life; Kuala Lumpur; On-site; MYR 50,000 - 70,000; Full time

Job summary

A leading insurance company in Malaysia is seeking an Associate for Network Management. The role involves managing provider relationships, ensuring compliance with healthcare standards, and enhancing service delivery. Ideal candidates will have a degree in healthcare and relevant experience.

Qualifications

• 2-3 years of experience in healthcare and insurance.
• Knowledge of healthcare billing, medical terminology, and coding.

Responsibilities

• Manage provider contracting and develop guidelines.
• Ensure compliance with standards set by regulatory bodies.
• Conduct monthly Quality Assurance checks for the payment team.

Skills

Communication

Analytical

Problem-Solving

Organizational

Education

University Degree

Job description

Job Description - Associate, Network Management (250000EX)

Job Number:

250000EX

About the Job

Discover the GREAT in your career.

As a LIFE company, our customers are at the heart of all that we do. Being one of Asia’s leading insurers for over a century, we have built a long-lasting legacy of trust with our customers over many generations. This trust is rooted in our core values: Integrity, Initiative, and Involvement. We treat every customer relationship with honesty and transparency and proactively deliver the best solutions in life and general insurance.

If you are looking to grow in an exciting career filled with opportunities, we are seeking an ideal candidate to join as an Associate, Network Management.

Job Purpose

• Educate providers and employees in the network on Company’s managed care philosophies, policies, and procedures.
• Ensure network providers deliver services according to Company guidelines, standards, and fee schedules.
• Monitor provider behavior regarding utilization, care quality, and cost.

The Job

• Manage provider contracting, including fee or volume discounts.
• Develop and implement guidelines and benchmarking in network management.
• Handle complaints/disputes from regulating bodies, policyholders, and agents related to hospital matters.
• Identify issues affecting the network and propose corrective strategies.
• Ensure providers meet cost efficiency and quality service expectations.
• Meet service delivery and productivity benchmarks in accordance with standards.
• Engage with providers for collaboration and relationship building.
• Administer network management and provider settlements efficiently.
• Ensure compliance with standards set by regulatory bodies and auditors.
• Perform tasks such as scoring and documentation for new panelship.
• Attend to additional tasks as assigned.
• Conduct monthly Quality Assurance checks for the payment team.
• Consider business and regulatory compliance risks and take steps to mitigate them.
• Stay informed on industry trends, emerging threats, and technologies.
• Identify potential risks and share best practices in risk management.

Our Requirements

• University Degree in any discipline, preferably in healthcare or health administration.
• 2-3 years of experience in healthcare and insurance.
• Concern for order, teamwork, and cooperation.
• Knowledge of healthcare billing, medical terminology, and coding.
• Strong communication, analytical, problem-solving, documentation, and organizational skills.
• Good knowledge of healthcare delivery systems and hospital billing management.
• Maintain good relationships with hospitals, network panels, and doctors.
• Self-motivated and able to work under pressure.
• High integrity, accountability, and positive attitude toward teamwork.
• Proactive in improving processes and adaptable to change.

Location: Great Eastern Malaysia, HQ

Entity: Great Eastern Life Malaysia

Employment Type: Permanent

Note: Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or employees. We are not responsible for fees related to unsolicited resumes.