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Physician Engagement, Specialist page is loaded

Apply locations Kuala Lumpur, MY-AIA Malaysia time type Full time posted on Posted Yesterday job requisition id JR-56444

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About the Role

To manage cost and cost containment efforts for covered members and policyholders of AIA health insurance policies related to specialist costs. To build cordial business relationships with specialist doctors, medical directors, and panel providers and ensure medical claims costs are contained effectively with regular performance dialogues, scorecard management, and monitoring of utilization with the use of analytics.

Roles & Responsibilities:

1. Specialist Management

1. New Specialist Panel-ship.

• To manage and grow a network of specialist doctors who provide cashless and cost-efficient service to covered members including recruitment, utilization management, and termination.
• To provide the relevant assessment study for new specialists and provide recommendations based on credentialing guidelines and cost requirements.

• To create an engagement platform with medical directors, hospital management, and specialists (as required) as an opportunity to highlight cost and behavior of specialists to improve.
• To provide and receive feedback from specialists, medical directors, and heads of departments from providers by monitoring behavior and evaluating the performance of specialist doctors based on claims utilization, market best practice, service level, adherence to fee schedule, and possible fraud for mutual improvement.

• To arrange and manage specialist communication, engagement sessions, and appeal process to enable a feedback loop to ensure cost is managed.

2. Scorecard Management and Review

• To create and manage specialist doctor’s scorecard to monitor specialist cost.
• To engage with medical directors and specialists to explain and understand scorecards.
• To monitor specialist cost and decide on specialist removal, continue within watchlist etc. for further action.

3. Internal & External Communication

• To provide timely communications internally (to AHS), and externally to providers and hospital management to inform on the status of specialists.
• To proactively manage specialists' inquiries and manage the relationship with medical directors alongside the hospital network partnership team.

4. Health Analytics

• To provide actionable insights from the relevant dashboards related to specialists.
• To provide actionable insights from data and audit findings on cost, quality indicators of specialists specifically; average cost, Length of Stay, and bill size statistics (Percentiles and Probabilities) especially for scorecard management.
• To support on performing quarterly bill reviews of specialists from specific hospitals, or specialty for diagnosis/procedures for identifying major cost contributors in the bill.
• To identify the right procedures, providers, and pricing for package pricing and any cost containment related initiatives.

5. Cost Management

• To participate with the team in executing Specialist Management Strategy to achieve targeted medical inflation targets.
• To maximize cost savings on specialist cost management.
• To support special projects that may incur significant savings and impact on medical inflation.

Minimum Job Requirements:

• Degree in Health or Life Sciences, Allied Health or relevant disciplines.
• Working experience in healthcare or 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, willing to travel for job assignments.

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

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.