Partner & Provider Coordinator
• To ensure all documents and contracts are up to date in the systems (i.e. Shared Folder and Shared Point) on a yearly basis
• To ensure the network list is updated monthly and shared with the concerned departments
• To update all providers on Facility Finder and SWAN
• To manage the reconciliation reports of the providers and liaising with the concerned internal departments and Network Consultants
• To provide and maintain Provider World accounts for network providers and service partners.
• To co-ordinate all operational activities of service partners and ensure efficiency and delivery of auditable savings.
• To manage relationship with service partners in region and deliver effective cost containment solutions.
• To support the positioning of our Global as the expert in the international healthcare arena.
Freedom of action/Dimensions:
• Decision making remit will be for day to day operations.
• Authority as per our Global Delegated Authorities framework. Will consult with other team members, Service Managers and the Continuous Improvement Partners.
Provider Contract Renewal and Maintenance
• Communicating renewal document details to contracting consultants.
• Linking duplicate providers in SWAN and maintaining department central provider record sheet.
• Update information and maintain records in SWAN, Shared Folder and Shared Point regarding contracted providers.
• Support on provider information on FF
• Updating the network list monthly to be shared with the concerned departments
Claims and Payment Queries
• To investigate statements of out-standing accounts from participating providers with the concerned claims teams
• Investigate aged –debt queries
• Manage claim reconciliations in the region and share the investigated reports with clear explanation of our Global Decisions with Contracting Managers for any negotiations taken forward with the provider
Provider World (on-line portal for providers and TPAs)
• Unlock ProviderWorld accounts and reset account information; delete users from PW where appropriate for network providers and service partners.
• Provide usage feedback/escalate issues to Relationship Owners.
• Communicate well in advance with all Service Partners and Providers of all site changes or enhancements.
• Drive high level of provider satisfaction by handling providers’ PW requirements proactively.
Service Partner Management:
• Proactively work with a portfolio of our Global’s Service Partner (TPA) relationships (and their Providers) in the region to ensure delivery of effective operational processes to support cost containment activities
• Support the TPA Development & Contracting Managers in evaluating TPA performance (including monthly reports, quarterly reviews and quality audits)
• Coordinate and follow up on effective query resolution across a number of stakeholders including internal customers, brokers, TPAs and providers
• Work with the TPA Development & Contracting Managers to maintain effective working relationships with partners, providers and internal our employees and departments to ensure delivery of TPA objectives.
• Conduct regular operational calls covering pre-authorisation, complex cases and claims administration
• Streamline processes to ensure operational efficiencies within BG and the TPAs
• Assist in developing the tools for maximising TPA efficiency, and avoiding duplication of tasks
• Produce regular activity reports in agreed formats
• Complete partner governance monthly reports
• Complete Quarterly reviews for service partners
• Work positively in association with colleagues especially in Healthcare Services, Claims and our Global.
• Set expectations with providers on incoming queries on reconciliation and turnaround times.
Delivering fair outcomes for consumers and Understanding your regulatory obligations:
• Put fair treatment of providers and service partners at the heart of what you say and do. Be courageous and speak up if you believe our products or services do not deliver what we have led our providers to expect.
• Be accountable and take ownership for ensuring you are familiar with all regulatory requirements that fall within the remit of your role and comply with them at all times. Seek guidance if you need support understanding your regulatory requirements. Notify, without delay, any potential or actual breach of regulation.
• To maintain governance and control requirements, ensuring all internal governance requirements are met, including full compliance with all policies, audit actions, monitoring actions and risk appetite.
• Bachelor’s degree or above
• Conduct Business trips when necessary
• Nursing or medical background will be plus.
Ideal experience and delivered performance
• Background in the global health insurance market, or relevant transferable skills and knowledge from other financial services industries such as Life Insurance, Retail, hospital or clinic, Commercial or Investment Banking and Wealth Management.
• Previous experience of a complex and multi skilled customer facing roles within a contact centre setting
• A track record of achieving and exceeding productivity and quality targets
• Highly customer focussed
• Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
• Ability to speak English and Mandarin languages is a must.