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Hospital Network Partnership, Specialist

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AI-generated summary

  • Liaise with hospitals and specialists; control costs, handle claims, detect fraud.
  • Purpose-led insurer helping millions live Healthier, Longer, Better Lives.
  • Hands-on role shaping care quality, speeding claims and advancing e-claims!

Undisclosed

Kuala Lumpur, MY-AIA Malaysia, Kuala Lumpur

Job Description

Start building a career with purpose.


At AIA, your perspective, curiosity and ideas can contribute to our Purpose of helping millions of people live Healthier, Longer, Better Lives. Across our diverse markets, you will learn through meaningful work, collaborate with experienced colleagues and build practical skills as you turn fresh ideas into positive outcomes and a more sustainable future for our customers and communities.


Join us to explore new possibilities, grow through real experiences and start making an impact across Asia.


About the Role


To serve as the key liaison between AIA/AHS and panel hospitals, ensuring effective relationship management, cost containment, claims coordination, and operational excellence. The Medical Officer will play a critical role in building relationships with specialist doctors in hospitals, ensuring the delivery of the right services at the right time and cost. Additionally, the Medical Officer will enhance service quality, detect fraud, and support digital transformation initiatives within hospital settings.

Roles and Responsibilities:


1. Relationship Management

  • 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.

2. Cost Management

  • 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.

3. Fraud Detection & Risk Management

  • 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.

4. Claims Handling

  • 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.

5. Operational Efficiency & Process Improvement

  • 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.

Minimum Job Requirements:


Qualifications & Experience:

  • 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.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.


Job Requirements


Company Benefits

Wellbeing support

We offer a range of wellbeing tools and programmes to help you think well, feel well, plan well and live well.

Opportunities for career growth

With our diverse up-skilling, mentorship, job mobility and career experiences, we will help shape your career, your way.

Diverse team culture

It's our differences that make us better together. We empower you to be your best and make a difference in your own unique ways.


Additional Info

Company Activity

Last active - few hours ago

Job Specialisation


Company Profile

AIA Malaysia (Insurance)-logo-image

AIA Malaysia (Insurance)

Do you believe in helping shape a better, more sustainable future? As the largest listed company on the Hong Kong Stock Exchange, we've been proudly making a difference for people and communities across Asia for over a century. And we build on this every day with our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030. Source: AIA Careers Page