Strategic Purchasing Executive at Jubilee Insurance

Job Ref. No: JHIL091

Role Purpose

As the Strategic Purchasing Executive, you would be responsible for establishing and maintaining relationships with healthcare providers to ensure a robust and high-quality network of medical services for policyholders. This role involves collaboration with internal and external stakeholders to optimize provider partnerships.

Main Responsibilities
Strategy

• Maintain relationships with Specialists, administrative staff for specialists and other key Specialists’ influencers and provide a clear link between these and Jubilee Health Insurance.
• Act as a liaison between Specialists and Jubilee Health Insurance limited to resolve problems, provide, and obtain information, and maintain positive working relationships with Specialists.

Operational

• Negotiation of cost of services rendered by medical providers.
• Monitoring Average Costs of providers and engaging high-cost providers for cost reduction.
• Implement initiatives that help reduce the cost of drugs such as drug delivery, generic drugs utilization among others.
• Develop a tracking system for and ensure timely follow-up of doctors’ payments is done.
• Ensuring all cost Agreements have been Setup in the System, i.e., Co-pays, Discounts, Micro Schemes and Restricted Categories/Providers.
• Provide guidance to the care management team, claims team, and contact center agents on provider cost issues.
• Support the business development and underwriting team in client servicing.
• Monthly reports on effectiveness of systemized cost control and saving achieved.
• Pre-authorisations monitoring to determine IBNR.
• Providing a report on claims status. Indicating outstanding claims, assessed and registered claims.
• Link, guide and communicate with prospective specialists through the credentialing process.
• Document all Specialists office interactions and other pertinent information in applicable databases to provide an accurate record of Specialist encounter history.

Corporate Governance

• Assist in carrying out country-wide provider audits to ensure that quality, cost effective medical services can be guaranteed for clients.

Leadership & Culture

• Promote a customer-centric approach to provider partnerships, prioritizing policyholder satisfaction and positive health outcomes.
• Collaborate with internal stakeholders to drive cultural transformation and organizational alignment around provider partnership goals and strategies.

Key Competencies

• Negotiation
• Performance reporting and management.
• Relationship Building skills
• Health Benefit Plan Management.

Qualifications

• Diploma in Nursing/Diploma in Clinical Medicine & Surgery
• Basic understanding of the concepts of insurance
• Proficient in the use of Microsoft office suite and packages

Relevant Experience

• Minimum of 2 years of relevant working experience in Case Management