Provider Relations Officer Ãâ¢ã‚â€ã‚â“ Microinsurance

About the Role

Reporting to the Assistant Manager provider & Forensic Management, the role holder will contract medical service providers, acting as a link between them and CIC, and ensure that providers act within agreed terms.

Key Responsibilities:

• Negotiate fees upon contracting new service providers, on all aspects, i.e. consultation, procedures, inpatient and other costs;
• Train service providers on changes at CIC in terms of health products, changes in existing processes, new schemes on board, terminated schemes on smart and underwriting rules to enable better service to clients;
• Conduct impromptu audits of the medical service providers, to ensure all our contracted providers adhere to CIC rules and procedures regarding member access to service and policy exclusions;
• Liaise with the Sales, Underwriting care and claims teams to resolve service provider issues identified at inception of schemes;
• Facilitate the Contracting, suspension and termination of providers from the panel based on adherence to working terms and conditions.
• Negotiate for discounts with service providers and ensure the discount is earned as agreed by liaising with medical claims team and finance team.
• Proper documentation of all Service Provider contracts and ensuring that the contracts are up to date.
• Manage the provider Network and empanel new providers to meet clients' needs in terms of service access.
• Address complaints in relation to service delivery issues, customer complaints and payment matters with the medical service providers.
• Analyze medical service provider utilization and develop appropriate strategic measures to manage and contain escalating medical cost.

Who We're Looking For

Essential Knowledge/Skills and Experience Required:

• Diploma in Nursing
• Minimum of 3 years of experience
• Diploma in Insurance is desirable.