Network And Healthcare Management & Strategy

Bring your career aspirations to life with AIA!Implementation of quality review of medical claims by conducting quality audit on panel providers (GP Clinics) with the objective of medical cost containment and cost efficiency.**Cost Management (30%)**:- To profile, analyze and identify GP claims trend to identify claims behaviors such as high cost, churning of visits, inappropriate billings, excessive referrals to specialists and MC issuance.- To support Sales team in reviewing and analyzing GP claims and utilization reports (C&U) of corporate clients. To seek recommendation and concurrent advice from Medical Advisor on proposed cost containment and health care management strategies based on the C&U findings.**Quality Management (30%)**:- To conduct monthly on site clinic audits to manage complaints received from HR and insured members on services by panel GPs.- To conduct half yearly quality audit of AIA Panel Labs.To work closely with Provider Management admin team on 2 yearly renewal of GP panel ship and periodic mass communications to all GP.- To compile and provide profile reporting of panel GP audit/ analysis findings for presentation to the Panel Selection Committee (PSC) for further recommendation on remedial actions.**Support & Complaint Management (10%)**:- To attend to requests submitted via OSC (One Stop Centre) and Talk 2Med within the stipulated turnaround time. (This includes sourcing for speaker for health talk for corporate clients, making special arrangement for collection of medications, pre-employment health screenings, annual / periodic health check & screenings etc.).- To handle complaints from internal and external clients on GP claims, services related issues by clinics, suspected high cost, churning of visits, MC related issues etc.- To perform sound assessment and decision-making on healthcare / benefits enquiries according to business rules and guidelines.- To provide support to GP claims team & panel GPs on enquiries related to claims, panel GP Working Arrangement and Schedule of Procedures and fees.**Miscellaneous & Special Projects related (30%)**:- Implementation of Drug Capping for GP claims portal- To have all GP panel providers to acknowledge the revised version of GP Working Arrangement ( updated Letter of Acceptance)- To participate in ad hoc projects assigned by supervisor.- T0 perform other responsibilities and duties periodically assigned by supervisor in order to meet operational requirements