Hospital Network Partnership, Specialist

AIA; Kuala Lumpur; On-site; MYR 90,000 - 150,000; Full time

Job summary

AIA Shared Services is seeking a Medical Officer to act as the primary liaison between AIA/AHS and panel hospitals, ensuring cost containment, claims coordination, and service excellence. The role emphasizes fraud detection and supporting digital transformation within hospital settings.

The candidate will build relationships with hospital doctors and management, monitor costs, verify medical necessity with claims teams, and drive process improvements to enhance customer outcomes across Asia.

Qualifications

• MBBS or equivalent medical degree with full registration.
• Minimum 3 years of clinical experience, preferably in private hospital settings.
• Strong interpersonal and communication skills; confident and outspoken.
• Ability to build rapport with hospital stakeholders and collaborate.
• Analytical mindset with attention to detail in claims and billing practices.
• Problem-solving and proactive approach; able to work independently and with internal teams.
• Familiarity with insurance/TPA operations is an added advantage.
• Willingness to be based at or travel frequently to assigned hospitals.

Responsibilities

• Relationship Management: Build and maintain relationships with hospital management, doctors, and medical staff; act as liaison between AIA/AHS and panel hospitals; engage with hospital administrators to review service quality and cost efficiency.
• Cost Management: Monitor treatment costs and billing practices; verify medical necessity with claims team; educate hospital staff on policies and guidelines.
• Fraud Detection & Risk Management: Identify potential fraud; conduct audits on high value claims; mitigate risks with the fraud investigation team.
• Claims Handling: Support fast-tracking of urgent claims; mediate disputes; guide policyholders on procedures and documentation.
• Operational Efficiency & Process Improvement: Provide feedback on hospital operational challenges; assist in digital initiatives like e-claims processing and cashless systems.

Education

MBBS or equivalent

Job description

Start building a career with purpose. At AIA, your perspective, curiosity and ideas can contribute to our Purpose of helping millions of people live Healthier, Longer, Better Lives. Across our diverse markets, you will learn through meaningful work, collaborate with experienced colleagues and build practical skills as you turn fresh ideas into positive outcomes and a more sustainable future for our customers and communities. Join us to explore new possibilities, grow through real experiences and start making an impact across Asia.

About the Role

To serve as the key liaison between AIA/AHS and panel hospitals, ensuring effective relationship management, cost containment, claims coordination, and operational excellence. The Medical Officer will play a critical role in building relationships with specialist doctors in hospitals, ensuring the delivery of the right services at the right time and cost. Additionally, the Medical Officer will enhance service quality, detect fraud, and support digital transformation initiatives within hospital settings.

Roles and Responsibilities

• 1. Relationship Management Build and maintain strong, professional relationships with hospital management, doctors, and medical staff. Act as the primary liaison between AIA/AHS and panel hospitals to address concerns, resolve disputes, and ensure smooth collaboration. Conduct regular engagement sessions with hospital administrators to review service quality, cost efficiency, and process improvements. Engage with specialist consultants in private hospitals to foster collaboration and alignment with AIA's clinical direction and strategic goals. Encourage and support specialist doctors in working with AIA by building trust, understanding their needs, and aligning mutual objectives.
• 2. Cost Management Monitor treatment costs and billing practices to ensure alignment with AIA/AHS cost containment strategies. Collaborate with the claims team to verify medical necessity and prevent overcharging. Educate hospital staff on AIA/AHS policies, clinical guidelines, and preferred treatment pathways.
• 3. Fraud Detection & Risk Management Identify and report suspicious billing patterns or potential fraud cases. Conduct audits on high value claims to detect anomalies and ensure compliance with internal standards. Work closely with the AHS fraud investigation team to mitigate risks and uphold integrity.
• 4. Claims Handling Support the fast-tracking of urgent and high-priority claims. Mediate and resolve claim disputes between hospitals and AIA efficiently. Guide policyholders on claims procedures, eligibility, and documentation to enhance customer experience.
• 5. Operational Efficiency & Process Improvement Provide feedback to internal teams on hospital operational challenges and suggest actionable improvements. Collaborate with the network management team to optimize panel hospital performance and selection. Support digital initiatives such as e-claims processing and cashless payment systems.

Minimum Job Requirements

• Qualifications & Experience: Medical degree (MBBS or equivalent) with full registration.
• Minimum 3 years of clinical experience, preferably in private hospital settings.
• Strong interpersonal and communication skills; must be confident and outspoken.
• Proven ability to build rapport with hospital stakeholders and work collaboratively.
• Analytical mindset with attention to detail in claims and billing practices.
• Strong problem-solving skills with a proactive and solution-oriented mindset.
• Ability to work independently while collaborating with internal teams.
• Familiarity with insurance/TPA operations is an added advantage.
• Willingness to be based at or travel frequently to assigned hospitals.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

"Better" starts with people who reimagine what is possible and turn ideas into meaningful action. At AIA, you will contribute in your own way, help shape outcomes that matter and collaborate with colleagues across disciplines, teams, markets and levels. We will support you to broaden your perspective, strengthen your capabilities and grow your impact. Together, we challenge assumptions, learn from one another and find better ways forward. Bring your ambition, experience and ideas to AIA, and help shape what "better" looks like.