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.
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
Application Procedure
If you meet the above requirements, you are encouraged to forward your application and updated CV to [email protected] by 2nd August,2024. Clearly state the job title on the subject heading. Heritage is an equal opportunity employer and actively encourages diversity. Please note that only shortlisted candidates will be contacted.
