Senior Manager, Health Services - Network Management
AIA Hong Kong and Macau
jobsDB ref: JHK100003004998681
Employer Ref. 17067
Responsible for establishing the strategy, creation, direction and evolution of the provider network. The incumbent shall (1) liaise with providers and conduct ongoing evaluation of network performance so as to ensure a complete, stable, accessible well-regarded and high quality delivery system; and (2) to review the overall workflow of the Health Services functions and to streamline the procedures as necessary.
Supervise and lead team members to execute the functions of Network Management services
1. Setup and maintain provider network:
- Initiate and maintain network provider for health services.
- Administer credentialing process and operation of network provider.
- Establish working procedure and identify control process for compliance to ensure service standards.
- Accomplish the requirement for panel network to perform eligibility check and EDI claims submission for accuracy and efficiency.
- Conduct facility visits for ensuring accuracy in panel system setup and administration and service quality at clinic
- Monitor network adequacy.
2. Review network provider quality:
- Review daily call log on network provider (both corporate and life products) to identify areas for improvement.
- Provide recommendations to network providers after investigation of reported servicing issue (corporate and life products arrangement).
- Monitor network providers’ performance within the established service standard.
- Conduct regular meeting with Panel Network for utilization review and service excellence and plan for service improvement
- Plan and monitor timeline for fee schedule discussion and negotiation.
- Identify problems which affect the Network and proactively communicate with management for improvement plan
3. Contribute to network proposal for service arrangement / product development:
- Identify network provider combination in accordance with customer needs.
- Coordinate and negotiate with network provider to submit proposal.
- Prepare standard workflow, requirement and administrative guideline for implementation.
- Recommend and execute methodology for eligibility check includes IVRS, IEC, WEC and/or Panel File with explanation on specifications.
- Conduct pre and post service review for improvement.
4. Review workflow and system capabilities for efficient delivery of health services to clients and system interface with business partners:
- Review system performance and identify areas for technical support team to monitor for stability.
- Review system for enhancement for efficiency and convenience for clients
- Review system capability for eligibility via IVRS, IEC, WEC for identification and other checking alternatives
- Review overall current workflow and streamline as necessary
5. Other duties and responsibilities:
- Check and look for appropriate providers for the provision of health care services for enhancing customer satisfaction.
- Plan and design tailor made health check and other wellness programs
- Plan and design value added services for clients as required
- Responsible for leading the Provider Management strategy in Project Care and other project initiatives and other projects relating to service or system enhancement
- Other duties and responsibilities as assigned by supervisor.
- University Degree in Business Studies, Health Administration or relevant disciplines.
- Minimum 8-10 years relevant experience with at least 5 years in private healthcare industry and EB insurance benefits
- Customer service and presentation experience required.
- Strong business communication, analytical, planning, problem solving, documentation and organizational skills.
- Knowledge of Healthcare delivery, performance monitoring, electronic billing, medical service practice, industry practice, related ordinance and governance.
- Proficient in both spoken and written Chinese and English.
- Strong communication and negotiation skills.
We offer an attractive remuneration package to the successful candidate. Please submit your application by clicking “Apply Now” for our processing.
All personal information provided by applicant will be treated in strict confidence and used solely for recruitment purposes. The personal information will be used strictly in accordance with AIA’s personal data policies, a copy of which will be provided upon request. It is possible that information about the applicant or the applicant’s application will be shared with AIA and its related companies. AIA will retain all applications for a period of up to 24 months after which the documents will be destroyed.
About AIA Hong Kong and Macau
AIA International Limited
About AIA Hong Kong and AIA Macau
AIA Hong Kong and AIA Macau are subsidiaries of AIA Group Limited. AIA Group Limited established its operations in Hong Kong in 1931. We have more than 11,000 financial planners*, as well as an extensive network of brokerage and bancassurance partners who serve more than 1.8 million customers*. Our products range from individual life, group life, accident, medical and health, personal lines insurance to investment-linked products with numerous investment options. We are also dedicated to providing superb product solutions to meet the financial needs of high net worth customers.
* As of February 2016