Head / Associate Director, Provider Engagement &

5 days ago

Singapore AIA SINGAPORE PRIVATE LIMITED Full time

**Job Description Summary**

Work with Head, Healthcare and other key stakeholders across AIA Singapore to lead and drive provider engagement and clinical excellence agenda for AIA.
- 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 panel is adequate, consists of high quality doctors, and achieves cost savings for AIA
- Identify other opportunities for AIA to engage with healthcare providers and lead initiatives to expand AIA’s engagements in healthcare provider space (example - Value Based Contracting arrangements, bundled payments etc.)
- Develop provider negotiation and management strategies, including contracting, commercial negotiations, provider manuals, KPIs
- Negotiate provider contracts to ensure capture of commercial benefits for AIA whilst bearing in mind need to ensure quality and comprehensiveness of panel Monitor and audit quality of healthcare providers in AIA’s network, particularly AQHP providers, and engage providers to undertake remedial action where needed.
- Drive development of claims guidelines for assessment of medical necessity, including necessary alignment with Group Medical, Claims, Care, and Provider Management, and taking on board feedback from AIA’s provider network
- Drive development of clinical quality metrics, and enhancement of provider management to help ensure that our customers receive the best possible care
- Drive other initiatives to ensure clinical excellence in our provider network and ensure that claims assessment is medically appropriate.
- 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

**Requirements**:

- Medical degree, preferably from local university
- At least 10 years 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

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