Provider Management Officer

Job Summary The role holder will be responsible for service providers management, contracting, accreditation and audits. Key Responsibilities Maintain a cordial working relationship with providers within the Heritage Insurance provider network Accredit new service providers to meet the client’s needs/demands Negotiate service fees upon contracting of new service providers, guided by the Heritage Insurance rates and customary fees Coordinate provider audits to ensure quality services are accessed by Heritage Insurance clients Enforce compliance to Heritage rules and procedures regarding member access, policy exclusions and panel rates Coordinate with Underwriting/Actuarial & prepare monthly utilization report on performance of service providers and develop appropriate measures to contain cost Proper documentation of all service provider contracts and ensure timely renewal and KYC updates as per the set guidelines Train Service providers on Heritage Insurance service access procedure/processes, update on any changes at Heritage Insurance in term of health products, existing processes and other related claim policies Engage service providers in negotiation for discounts and close finance reconciliations Liaise internally with other sections to ensure resolution of service provider related issues Regular update of the Heritage Insurance provider panel and timely sharing with relevant stakeholders Qualifications Bachelor’s degree/Diploma in Nursing, Clinical Medicine, Pharmacy, or medical – related discipline Experience At least 3 years’ experience in provider relations in medical insurance, hospital or related industry Competencies Excellent communication and negotiation skills Good analytical skills Computer literate in MS Office and excel applications Good knowledge of provider dynamics and landscape Cost Optimization strategies

• Maintain a cordial working relationship with providers within the Heritage Insurance provider network • Accredit new service providers to meet the client’s needs/demands • Negotiate service fees upon contracting of new service providers, guided by the Heritage Insurance rates and customary fees • Coordinate provider audits to ensure quality services are accessed by Heritage Insurance clients • Enforce compliance to Heritage rules and procedures regarding member access, policy exclusions and panel rates • Coordinate with Underwriting/Actuarial & prepare monthly utilization report on performance of service providers and develop appropriate measures to contain cost • Proper documentation of all service provider contracts and ensure timely renewal and KYC updates as per the set guidelines • Train Service providers on Heritage Insurance service access procedure/processes, update on any changes at Heritage Insurance in term of health products, existing processes and other related claim policies • Engage service providers in negotiation for discounts and close finance reconciliations • Liaise internally with other sections to ensure resolution of service provider related issues • Regular update of the Heritage Insurance provider panel and timely sharing with relevant stakeholders • Bachelor’s degree/Diploma in Nursing, Clinical Medicine, Pharmacy, or medical – related discipline • At least 3 years’ experience in provider relations in medical insurance, hospital or related industry • Excellent communication and negotiation skills • Good analytical skills