Provider Relations Officer – Medical at CIC Insurance

PURPOSE:

Responsible for management of service provider in relation to contracting, accreditation and rationalization of existing service providers.

 PRIMARY RESPONSIBILITIES:

• Maintain a cordial working relationship with providers within CIC provider network.
• Perform provider audit to ensure quality services is accessed by CIC clients and enforce compliance to CIC rules and procedures regarding member access and policy exclusions.
• Accredit new service providers to meet the client’s needs/demands.
• Prepare monthly utilization report on performance of service providers and develop appropriate measures to contain cost.
• Negotiate service fees upon contracting of new service providers, guided by the CIC rates and standard customary fees.
• Proper documentation of all service provider contracts and ensure timely renewal as per the set guidelines.
• Train Service providers on CIC service access procedure/processes, update on any changes at CIC in term of health products, existing processes, new schemes on board, terminated schemes and other related claim policies.
• Engage service providers in negotiation for discounts and follow up to ensure it’s earned.
• Liaise internally with other sections to ensure resolution of service provider related issues.
• Regular update of the CIC provider panel and timely sharing with relevant stakeholders.

Academic and Professional Requirements

Education  

• Bachelor’s degree in Nursing(KRCHN), Health Management or in a related field    E
• Computer literate in MS Office and other office applications    E

Experience Required:

• 2 years Relevant experience in Provider Relations Section