Executive / Senior Executive, Benefit Package & Pricing

Protecthealth Corporation; Sepang; On-site; MYR 90,000 - 130,000; Full time

Job summary

ProtectHealth Corporation in Malaysia is seeking an Executive/Senior Executive to support development, evaluation, pricing and continuous improvement of healthcare benefit packages. You will conduct HTA, cost analyses and market research to ensure clinically appropriate and financially sustainable offerings.

You will collaborate with Operations, Legal and external stakeholders to ensure practical implementation, negotiate with providers, and monitor programme performance for value-for-money and

Qualifications

• Bachelor's degree in Medicine, Biomedical Science, Life Science, Public Health, Pharmacy, Healthcare Management, Business Studies or an equivalent professional qualification.
• Master's degree in Public Health, Health Policy, Health Financing or related field is an added advantage.
• Experience in healthcare benefit design, pricing, HTA or related programme development is advantageous.
• Strong research, analytical and problem-solving capabilities with evidence-based approach.

Responsibilities

• Support design, review and enhancement of healthcare benefit packages across primary care, chronic disease management, medicines, preventive services and specialised treatments.
• Conduct literature reviews, HTA, market research to assess clinical benefit, cost-effectiveness and appropriateness of services.
• Analyse utilisation, cost information and market trends to support pricing decisions and risk identification.
• Perform pricing, reimbursement, cost and market benchmarking analyses for pricing approaches.
• Support provider sourcing, evaluation and negotiations focusing on quality of care and value for money.
• Assist in provider payment design, including capitation, DRG, bundled payments and global budgets.
• Assess cost-sharing mechanisms to promote appropriate utilization and financial sustainability.
• Prepare analyses, business proposals and reports to communicate findings to management.

Skills

Health economics

Data analysis

Negotiation

Stakeholder management

Communication (English/Bahasa Malaysia

Education

Bachelor's degree in a health-related field

Tools

Excel

PowerPoint

Microsoft Teams

Job description

Protecthealth Corporation - Sepang, Selangor

The Executive / Senior Executive, Benefit Package & Pricing is responsible for supporting the development, evaluation, pricing and continuous improvement of healthcare benefit packages to advance ProtectHealth's strategic purchasing objectives.

The role undertakes evidence-based research, health technology assessments (HTA), healthcare market and cost analysis, provider evaluation, and financial assessments to support the development of benefit packages that are clinically appropriate, financially sustainable and responsive to population healthcare needs.

The incumbent will also support healthcare provider sourcing and negotiations, development of appropriate provider payment and financing mechanisms, programme implementation, and performance monitoring. Working closely with internal and external stakeholders, the role contributes towards achieving quality healthcare outcomes, value for money and sustainable healthcare expenditure.

Key responsibilities

Support the design, review and enhancement of healthcare benefit packages covering areas such as primary care, chronic disease management, prescription medicines, preventive services, wellness initiatives and specialised treatments.

Conduct and coordinate literature reviews, health technology assessments (HTA), market research and other evidence-based analyses to assess the clinical benefit, cost-effectiveness and appropriateness of healthcare services, medicines and technologies for potential inclusion in benefit packages.

Analyse healthcare utilisation, cost information, market trends, emerging technologies and supply-demand dynamics to support benefit package development, pricing decisions and identification of potential opportunities and risks.

Conduct pricing, reimbursement, cost and market benchmarking analyses to support the development and review of appropriate pricing approaches for healthcare programmes, services and products.

Support the sourcing and evaluation of healthcare providers and suppliers, considering quality of care, pricing, service capability, operational requirements, cost-effectiveness and overall value for money.

Participate in provider and supplier negotiations, working closely with relevant internal stakeholders including Operations and Legal to support commercially sound contractual arrangements and favourable terms and conditions.

Support the design, assessment and implementation of provider payment and healthcare financing mechanisms, including capitation, diagnosis-related group (DRG) payments, bundled payments and global budgets, as appropriate to programme requirements.

Support the assessment of relevant cost-sharing mechanisms, including deductibles, co-payments and co-insurance, where applicable, to promote appropriate utilisation, financial sustainability and efficient healthcare delivery.

Conduct financial and cost analyses to assess the potential impact of proposed benefit, pricing and payment arrangements and support recommendations that promote fair value and cost-effective service delivery.

Assist in budget forecasting, expenditure reviews and performance monitoring to support cost containment, financial sustainability and continuous improvement of healthcare programmes.

Support the deployment and implementation of new healthcare programmes, plans and schemes by translating approved benefit packages, pricing arrangements and programme requirements into practical implementation activities.

Develop clear communication materials relating to benefit details, coverage limitations, eligibility and access procedures to facilitate effective stakeholder understanding and programme implementation.

Collaborate with cross-functional teams including Operations, Finance, Legal and other relevant stakeholders to ensure benefit, pricing and programme proposals are practical, compliant and operationally feasible.

Engage healthcare providers, suppliers, industry stakeholders, subject-matter experts and other external parties to obtain relevant information, validate assumptions and support programme development and implementation.

Monitor programme and benefit performance through relevant utilisation, cost, expenditure and performance indicators and identify opportunities for continuous improvement.

Prepare analyses, business proposals, reports, presentations and management papers to communicate findings, recommendations, risks and proposed actions to Management and relevant stakeholders.

What we're looking for

Bachelor's degree in Medicine, Biomedical Science, Life Science, Public Health, Pharmacy, Healthcare Management, Business Studies or an equivalent professional qualification from a recognised institution.

A Master's degree in Public Health, Health Policy, Health Financing or a related field will be an added advantage.

Relevant experience within a healthcare setting such as a health insurer/takaful operator, healthcare provider, Health Maintenance Organisation (HMO), managed care organisation or healthcare-focused consulting firm.

Experience or exposure in areas such as healthcare benefit design, healthcare financing, provider payment mechanisms, healthcare pricing, reimbursement, provider contracting, strategic purchasing, health technology assessment (HTA), healthcare analytics or programme development will be advantageous.

Experience in data analysis and business proposal development, with the ability to translate evidence and findings into practical recommendations.

Strong understanding of the Malaysian healthcare landscape and healthcare contracting processes will be an advantage.

Strong research, analytical and problem-solving capabilities with the ability to evaluate evidence, data, costs and market trends.

Good negotiation and stakeholder management capabilities, with the ability to build effective working relationships with healthcare providers, suppliers and internal stakeholders.

Good project management and organisational skills, with the ability to manage multiple priorities and deadlines in a fast-paced environment.

Excellent written and verbal communication skills in English and Bahasa Malaysia, with the ability to communicate complex healthcare and financial information clearly.

Ability to work collaboratively within multidisciplinary and cross-functional teams while also operating independently with appropriate supervision.

Proficiency in Microsoft Excel and PowerPoint and collaborative platforms such as Microsoft Teams.