Healthcare Provider Network Management, Senior

7 months ago

Ho Chi Minh City, Vietnam Prudential plc Full time

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

The role requires to strategist across various area of healthcare area from providers, payers, and hospitals network with strong understanding of the trends, opportunities, and challenges.

The incumbent need to vision beyond the quality of PVA HealthCare outsourcing and strategically plan the HealthCare business aligning and leveraging on group business support and directive in implementing client’s strategists to identify and determine creative solution to improve business using business administrative and finance to enhance the overall success or PVA.

**Job Description**:

- To manage the claims submission and payment execution for the central & southern regions with close collaboration and discussion with other regions in strategizing the action plan to manage the healthcare providers.
- To review & revisit the expectation of KPI delivery of service provider and ensure the procurement requirement. Evaluation and submission of detail audit, seeking change is being executed and comply to risk & compliance requirement.
- To contact and connect with vendor and managing vendor correspondence in view of proposal request, proof of concept, preparation of requirement, probing of the effectiveness and prepare an executive summary for selection of vendor.
- To be self-drive in communicate and preparing requirement of project including budgeting the expense proposal, conducting meetings with internal & external stake holders to discuss, strategist and to execute the HealthCare projects.
- To work closely with group strategist on project drive with group collaboration & able to articulate the ideas, suggest the collaborative action, overseeing the implementation and close gaps to enhance the goal achieve as planned.
- To be able to drive the growth of organic business with internal stake holders include product and marketing team through collaboration with HealthCare project in creation of awareness for preventive medicine, promote health activity and provide protection awareness through PVA Healthcare products.
- To be able to set up PVA own preferred providers that work closely with PVA in collaboration on case management, cost containment with gold standard and recognize treatment to all our healthcare client.
- To be able to review, discuss the process, payment mode and account holders & maintenance with possible discount negotiation and package price & executing the signing of new empaneling agreement working together with internal legal team and individual panel hospital.
- To be able review, renew agreement with prior discussion as when the time is right and due. Also to be able to discuss any dispute encountered in the process, observing of fraud and collusion which warrant an instant of termination of service agreement.
- To uplift the scale and support PVA regional manager and hospital ambassador in building relationship with hospital providers in general, and through implementation of project and initiatives’.
- To be able to support the team in conducting the presentation to selected hospital for specific group of client/VIP program on fast service, any additional exception service for selected Healthcare riders.
- To support manager on training, to share the expectation of insurer in dealing agents or leaders, implementation, and communication on watchlist action to high claims agency especially in suspicion of misconduct & fraud is evident.
- To be able to continuously attend / involve with training for personal and career development.

Undertake projects / other work and duties allocated by management as and when required.

Job Requirements

a. Qualification

Degree in HealthCare Management, Business Administrative, Business Management or legal and etc.

b. Experience

Preferably experience in Insurance business and Business Strategic Planning and healthcare Management will be an advantage. Working insurance company or banking at managerial level for at least 5 years.

c. Knowledge, Skills & Attributes

Insurance/Legal/healthcare management and project management,

Possess knowledge on Life Insurance claims processing.

Computer literate and familiar with MS Excel, MS Word & MS PowerPoint.. Self-assured and results oriented

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