Hospital Network Partnership, Consultant
- Kuala Lumpur
- Permanent
- Full-time
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.