Job Details

Competitive Package
Job Type
Sherry Lim
Contact email
Email Sherry
Contact phone
65 6692 9345
6 months ago
Join an international health insurer as a Medical Network Specialist. You will be responsible for medical network procurement and management for the health business. In this role, you will be part of a strategic exercise and team to review, monitor and refresh internal processes to achieve efficient and effective provider agreements. This would be an excellent opportunity for existing healthcare insurance professionals to develop and contribute their efforts into strategic costs reductions for the business. 

Key Duties:

  • You will  negotiate pricing, rebate, agreed fee/package fee with doctors/medical providers and establish agreements in order to obtain efficient economies of scale for the business. 

  • Complete due diligence formalities with all new/existing providers and conduct regular monitoring services, audit and handle complaint of service providers in order to be in line with the company’s risk management standards

  • Review and maintain providers’ contracts, update changes of providers’ information in order to strengthen relationships with the appointed providers.

  • Good documentation of new/existing processes, set SOPs and develop processes escalation hierarchy.

  • Identify and recommend any new service propositions such as cashless and digital customer journey to meet customers’ needs.

  • Investigate and provide complaints resolution in relation to service delivery failure, claims, payment matters with providers in order to be consistent with the company’s fair dealing outcomes.

  • Monitor quality of care from panel of providers, analyzes cost and utilization data to develop appropriate action plans to manage escalating medical costs in order to contain claim cost

  • Manage and communicate to key stakeholders on all key issues related to business lines in an effective manner in order to support health business objectives and needs.

  • Monitors monthly SLA reports on providers performance in terms of services and cost tracking in order to ensure business efficiency.

  • Good management of UAT controls for system changes and assists in the implementation and attainment of health department operational goals in order to enhance process workflow for operation efficiency.

  • Support ad-hoc projects and other duties as required.

Key Requirements:

  • Degree in any discipline.

  • Healthcare educational background will have an added advantage.

  • Minimum 3 years of experience in medical network management in an insurance or related industry.

  • A good team player with strong interpersonal relationship skills and highly self-driven.

  • Ability to coordinate a network of stakeholders from various backgrounds and understand business needs.

  • Proven ability in execution and meeting tight deadlines.

  • Dedicated, hardworking with a high level of integrity, sense of urgency and strong attention to detail.