Provider Engagement Specialist
1 month ago
We are seeking a highly skilled and experienced professional to lead our provider engagement and clinical excellence agenda for AIA Singapore Private Limited. As a key member of our team, you will be responsible for ensuring that our customers receive the best possible care and that our programme supports our brand promise to help our customers live Healthier, Longer, Better Lives.
Key Responsibilities:
- Lead engagements between AIA and healthcare service providers, including panel doctors, hospitals, day surgery facilities, home care services, and primary care providers.
- Manage AIA's Quality Healthcare Panel programme to ensure that the panel is adequate, consists of high-quality doctors, and achieves value for AIA customers.
- Identify opportunities for AIA to engage with healthcare providers and lead initiatives to expand AIA's engagements in the healthcare provider space.
- Develop provider negotiation and management strategies, including contracting, commercial negotiations, provider manuals, and KPIs.
- Monitor and audit the quality of healthcare providers in AIA's network, particularly AQHP providers, and engage providers to undertake remedial action where needed.
- Drive the development of claims guidelines for the assessment of medical necessity, including necessary alignment with Group Medical, Claims, Care, and Provider Management.
- Drive the development of clinical quality metrics and enhancement of provider management to ensure that our customers receive the best possible care.
- Support Care and Claims teams in the assessment of specific claims and appeals to determine if treatment is medically necessary and whether the treatment given is considered reasonable and customary care.
- Ensure compliance of AQHP and other contracted AIA healthcare providers with agreed fees and quality measures.
- Develop clinical quality metrics for the provider network and implement a structured approach to driving clinical quality agenda with providers.
- Develop medical guidelines for claims assessors, including ensuring alignment with Group Medical, Claims, Care, Provider, and local Exco.
- Measure customer satisfaction with AIA's network providers.
- Monitor cost-effectiveness and quality of care metrics related to medical management and care coordination.
Requirements
To be successful in this role, you will need to have:
- Strong communications skills, with the ability to communicate across AIA Singapore at top (Exco/CEO) and senior management levels within local business and Group.
- Ability to interact with the local medical community to support Provider team in performance dialogues and Care team in medical adjudication discussions.
- Medical degree, preferably from a local university.
- At least 8 years of working experience in healthcare, with exposure to clinical service development, clinical quality, and medical affairs.
- Good understanding of Singapore's healthcare system, particularly the setup of the private sector, and how clinical governance operates in the private sector.
About AIA Singapore Private Limited
AIA Singapore Private Limited is a leading life insurance company in Singapore, committed to helping our customers live Healthier, Longer, Better Lives. We offer a range of life insurance, health insurance, and investment products to help our customers achieve their financial goals and protect their loved ones. If you are passionate about making a difference in people's lives and want to be part of a dynamic and innovative team, we encourage you to apply for this role.
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