Job Summary

The role is responsible for Servicing providers management, contracting, accreditation, and audits

Key Responsibilities

• Maintain a cordial working relationship with providers within Heritage 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 rates and customary fees.
• Coordinate provider audit to ensure quality services is accessed by Heritage 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 service access procedure/processes, update on any changes at Heritage 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 provider panel and timely sharing with relevant stakeholders.

Requirements

Qualifications

• Bachelor’s Degree or Diploma in Nursing, Clinical Medicine, Pharmacy, or medical-related discipline

Experience

• 3 years’ experience in medical insurance/hospital or related industry

Competencies

• Understanding of health insurance operations and concepts
• Knowledge of medical claims processes and procedures
• Provider and stakeholder management
• Analytical skills, Customer service
• Delivering results and meeting customer expectations
• Coping with pressures and setbacks
• Analysing
• Working with people
• Adapting and responding to change
• Planning and organizing
• Presenting and communicating information
• Learning and researching
• Adhering to principles and values
• Achieving personal work goals and objectives