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.
How to Apply
