- Develop and maintain strategic partnerships with healthcare providers.
- Negotiate service agreements, tariffs, and terms with hospitals and clinics.
- Monitor provider performance in accordance with Service Level Agreements (SLA).
- Resolve operational issues and complaints from providers.
- Conduct regular reviews and evaluations of hospital services and claims processes.
- Coordinate with internal medical teams to validate complex claims and treatment procedures.
- Identify and mitigate risks related to fraud or misuse of services.
- Prepare performance reports and analysis for management review.
- Develop and maintain hospital performance reports for internal management.
- Collaborate with IT and operations teams to enhance digital integration of hospital data and claims systems.
Requirements:
- Min. Bachelor's degree in Medicine (Medical Doctor).
- Min. 3 years' experience in provider relations or hospital management within the insurance industry.
- Strong understanding of healthcare regulations and insurance claim processes.
- Required Skill(s): Negotiation, Communication, Analytical Thinking, Fluency in English