Care Analyst, Provider Relations

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