Job Details

Competitive Salary and Benefits
Job Type
Mimi Tay
12 months ago
My client is looking for a dedicated Medical Network Provider Management specialist. This is a well-established life and health insurance business, and you will report into the Senior Manager of the Group Health Claims team, and work closely with Head of Department to establish and negotiate competitive agreement terms with the medical network providers. Experienced health/medical claims professionals with strong exposure towards TPA management, and can demonstrate solid negotiation skills are encouraged to apply. This will be an international platform to develop your expertise further, with competitive salary and benefits for their staff.
Key Duties
  • 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.
Key Experience 
  • 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