Job Description
Liberty Life Assurance Kenya is a life insurance provider that has been providing relevant products to Kenyans for over 50 years. Our purpose at Liberty is to make a difference in people’s lives by making financial freedom possible. We change realities and make freedom possible by providing innovative and relevant solutions that help our customers prote…
Care Analyst, Provider Relations
Job Summary
The role holder will be responsible for service providers management, contracting, accreditation and audits
Key Responsibilities
- Maintain a cordial working relationship with providers within the Heritage Insurance provider network
- Accredit new service providers to meet the client’s needs/demands
- Negotiate service fees upon contracting of new service providers, guided by the Heritage Insurance rates and customary fees
- Coordinate provider audits to ensure quality services are accessed by Heritage Insurance clients
- Enforce compliance to Heritage rules and procedures regarding member access, policy exclusions and panel rates
- Coordinate with Underwriting/Actuarial & prepare monthly utilization report on performance of service providers and develop appropriate measures to contain cost
- Proper documentation of all service provider contracts and ensure timely renewal and KYC updates as per the set guidelines
- Train Service providers on Heritage Insurance service access procedure/processes, update on any changes at Heritage Insurance in term of health products, existing processes and other related claim policies
- Engage service providers in negotiation for discounts and close finance reconciliations
- Liaise internally with other sections to ensure resolution of service provider related issues
- Regular update of the Heritage Insurance provider panel and timely sharing with relevant stakeholders
Qualifications
- Bachelor’s degree/Diploma in Nursing, Clinical Medicine, Pharmacy, or medical – related discipline
Experience
- At least 3 years’ experience in provider relations in medical insurance, hospital or related industry
Competencies
- Excellent communication and negotiation skills
- Good analytical skills
- Computer literate in MS Office and excel applications
- Good knowledge of provider dynamics and landscape
- Cost Optimization strategies
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