- Ensure all signed agreements adhere to local regulatory and Corporate outsourcing guidelines and requirements.
- Maintain relationships with key hospitals, in-house panel Medical Providers and appointed TPAs.
- Ensure Letter of Guarantee (LOG) processes are adhered to by the providers.
- Develop and expand Medical Network to meet ever-growing customers' needs and demands.
- Negotiate with potential Medical Specialists for cashless facility and preferential outpatient, inpatient and surgical fees.
- Conduct annual due diligence assessments on appointed TPAs according to local regulatory guidelines and requirements.
- Monitor and ensure business efficiency and appointed TPAs' Service Level Agreements (SLAs) are met.
- Provide complaints resolution in relation to service delivery failure, claims, payment matters with Medical Providers, TPAs etc.
- Analyze hospitals and panel Specialists' utilization data to develop appropriate strategic measures to manage and contain escalating medical costs.
- Bachelor's Degree in Healthcare or equivalent combination of educational experience.
- At least 8 - 10 years of relevant experience in medical network management in Insurance / Medical Assistance Company / Third Party Administrators / Managed Care domain.
- Has an aptitude to negotiate, influence and collaborate
- Ability to manage Medical Providers, TPAs and all stakeholders
- Excellent written and communication skills.
- Excellent interpersonal skills and critical thinking skills
- A meticulous individual who is also a good team player
- Willingness to step up beyond the call-of-duty.
Reg No. R1547059
EBC Connect Pte Ltd
Licence no. 17C8975