VP Provider Management & Health Service - Health Insurance

An exciting VP Provider Management and Health Service (x 1 vacancy) job has just become available at one of the most respected health insurance company based in Bangkok.

About the VP Provider Management and Health Service Role:

In this business-critical role, you will be responsible for hospital network management/ pricing and contracting strategy, delivering the highest quality service. You will also take the lead providing direction to all contract negotiating and related projects.

The salary range for this role is base salary per month + provident fund + allowance + bonus.

Key Responsibilities:

• Developing network of health providers including (but not limited to) hospitals, clinics, physicians, lab, pharmacy, nursing care and care home to deliver services to ensure high quality medical care at a reasonable cost,
• Negotiating pricing agreements with providers
• Participating in health plan development related to directional network product, as well as developing preferred provider agreement for key corporate accounts.
• Developing value added services in conjunction with providers
• Coordinating and facilitating insurance claim processing to ensure minimum administration among network providers and company using new technology when appropriate
• Providing product knowledge training and on-going customer services to health care providers
• Maintaining a database of health care providers, their facilities, and charges, as well as performing analysis on medical utilisation, and take proactive actions with network providers to ensure appropriate treatment at reasonable cost
• Monitoring compliance with the contract, as well as perform regular hospital audit
• Evaluate criteria for retrospective case which defines criteria of medical necessity, quality, and cost effectiveness for utilisation management
• Participate in resolving unusual or complex problems/issues as they relate to inappropriate case
• Assure ongoing appropriate utilisation of services through concurrent review process and resolving problem by coordinate with hospital network
• Perform analysis on medical utilisation of hospital network to define high claimant customer in suspicious case or red zone area for pro-active investigation and collaborative working with Claims management
• Set strategy from medical management report to analysis and set action plan to UR team to control both simple disease and LR
• Review and analyse Medical Management Information System (MMIS) reports to identify utilisation patterns and individual providers or recipients who may be abusing the program
• Communicate with hospital networks to resolve instances of inappropriate utilisation
• Perform risk analysis to determine hospital networks, areas of concern and issues to be audited or retrospective review
• Resolve issues/conflicts between the intent of hospital network contracts
• Implement and monitor case action until case is closed
• Generate the Abuse/Miss utilisation Recoupment Report to management
• Set audit team to review inappropriate, fraud and abuse cases
• Preparing the contract of New hospital network and New Check-up Centre from hospital/clinic by printing
• Update the hospital network name list and Panel physician name list to post in drive
• Review all contract of hospital network to update services and discount

To succeed in the VP Provider Management and Health Service job, you will need to have the ability to work effectively and co-operatively with the senior business development teams, cross borders and internal matrix.

Key Requirements:

• Bachelor’s or master’s degree in Medical, Nursing, or related filed
• Minimum eight years of experience in medical management, case management or quality assurance
• Knowledge of commercial platforms for healthcare data analytics (e.g., Linguamatics, IBM Watson etc.)
• Knowledge of utilisation management/contract management
• Work experience in insurance, health industry, or related field
• Experience in negotiating & managing providers, managing provider data, produce reports and analysis
• Capable of resolving escalated issues arising from operations requiring co-ordination with internal departments & providers
• Experience in data analysis & presentations (Excel/ Powerpoint/ PowerBI)

This international health insurance firms need no introduction and is recognised as the leader in their field of expertise. With great clients and known for their corporate entertainment, they've won many awards. The culture is demanding but if you are confident and have a can-do attitude the potential rewards are significant. The firm is also very focused on developing and training their people to the highest standards.

If you are driven, determined and want to take the next step in your career, this is the role for you. Great career progression opportunities wait the right person in this exciting VP Provider Management and Health Service job.

Apply today for this new opportunity.

Due to the high volume of applications, our team will only be in touch if your application is shortlisted.

Robert Walters Recruitment (Thailand) Limited
Recruitment License No.: น. 1188 / 2551