Provider Relations Officer – Health at GA Insurance

Job Summary: The job holder will develop, manage, and sustain relationships with healthcare provider networks to secure high-quality and cost-effective health care services. The main goal is to shape a comprehensive and integrated health care system by fostering a seamless and efficient service network.

Duties and Responsibilities:

• Strategic Partnerships – continuous engagement with providers to ensure provision of high-quality, cost-effective care.
• Provider network management – maintain an updated provider panel, monitor adequacy of providers in all key regions and conduct provider audits. Update provider panel and Contacts to ensure the list is current and up to date.
• Provider relationship management – Develop and maintain strong provider relationships to enhance provider and customer experience and to ensure that providers adhere to the contract terms. Organize service meetings, training on GA processes, obtain provider feedback and share relevant reports on providers.
• Provider contracting –assist in contracting of providers and managing the provider contract lifecycle. While also ensuring all current and upcoming providers have signed contracts and have submitted all relevant documentation, carrying out system updates and filing of all relevant provider KYC documents and maintaining reports for the same.
• Customer service support – Support the business development and underwriting team through attending client service meetings to ensure delivery of superior customer experience.
• Compliance- Participate in collection and system updates of provider KYC and licenses to ensure compliance to any regulatory or health sector changes e.g., changes in the health legislation affecting the business and provide compliance reports promptly and as required.
• Cost containment- Negotiate costs, analyze provider costs, claims, and provide prompt reports and data to inform decision making in scheme cost controls.
• Assist in carrying out country-wide provider audits to ensure that quality, cost effective medical services can be guaranteed for clients.
• Provide guidance to, claims team, and contact centre agents on provider issues.

Academic and Professional Qualifications

• Diploma/bachelor’s in nursing or clinical medicine is preferred.
• Any insurance certification will be an added advantage

Experience

• At least 5 years of experience in clinical management or similar role
• Prior relevant experience in health insurance is preferred.
• Extensive knowledge of public and private healthcare providers in Kenya

Technical Competencies

• Proficiency in MS Package
• Experience in managing health insurance medical scheme services
• Knowledge of insurance industry and concepts and regulatory requirements
• Demonstrated experience in provider onboarding requirements in health insurance services management
• Working knowledge of diagnostic procedures within the Kenya healthcare system
• Experience in claims management within provision of medical scheme/ health insurance
• Knowledge of emerging trends and procedures in health insurance services management
• Experience in managing stakeholders in the health insurance services ecosystem
• Extensive networking with SP and other medical insurers.
• Excellent analytical and monitoring skills
• Good decision-making skills.

Behavioural Competencies

• Strong strategic focus and vision driven
• Strong problem solving, conflict management and decision-making capability
• Ability to build strategic relationships and network.
• Demonstrated team spirit and experience in team management through effective delegation and collaboration.
• High emotional intelligence and diplomatic sensitivity
• Ability to effectively manage resources.
• Ability to coach, mentor and develop talent.
• Strong interpersonal and communication skills.
• Strong client focus.
• High level of trust, integrity and dependability
• Innovative and ability to challenge the status quo.