Job Ref. No: JHIL091
Role Purpose
As the Strategic Purchasing Executive, you would be responsible for establishing and maintaining relationships with healthcare providers to ensure a robust and high-quality network of medical services for policyholders. This role involves collaboration with internal and external stakeholders to optimize provider partnerships.
Main Responsibilities
Strategy
- Maintain relationships with Specialists, administrative staff for specialists and other key Specialists’ influencers and provide a clear link between these and Jubilee Health Insurance.
- Act as a liaison between Specialists and Jubilee Health Insurance limited to resolve problems, provide, and obtain information, and maintain positive working relationships with Specialists.
Operational
- Negotiation of cost of services rendered by medical providers.
- Monitoring Average Costs of providers and engaging high-cost providers for cost reduction.
- Implement initiatives that help reduce the cost of drugs such as drug delivery, generic drugs utilization among others.
- Develop a tracking system for and ensure timely follow-up of doctors’ payments is done.
- Ensuring all cost Agreements have been Setup in the System, i.e., Co-pays, Discounts, Micro Schemes and Restricted Categories/Providers.
- Provide guidance to the care management team, claims team, and contact center agents on provider cost issues.
- Support the business development and underwriting team in client servicing.
- Monthly reports on effectiveness of systemized cost control and saving achieved.
- Pre-authorisations monitoring to determine IBNR.
- Providing a report on claims status. Indicating outstanding claims, assessed and registered claims.
- Link, guide and communicate with prospective specialists through the credentialing process.
- Document all Specialists office interactions and other pertinent information in applicable databases to provide an accurate record of Specialist encounter history.
Corporate Governance
- Assist in carrying out country-wide provider audits to ensure that quality, cost effective medical services can be guaranteed for clients.
Leadership & Culture
- Promote a customer-centric approach to provider partnerships, prioritizing policyholder satisfaction and positive health outcomes.
- Collaborate with internal stakeholders to drive cultural transformation and organizational alignment around provider partnership goals and strategies.
Key Competencies
- Negotiation
- Performance reporting and management.
- Relationship Building skills
- Health Benefit Plan Management.
Qualifications
- Diploma in Nursing/Diploma in Clinical Medicine & Surgery
- Basic understanding of the concepts of insurance
- Proficient in the use of Microsoft office suite and packages
Relevant Experience
- Minimum of 2 years of relevant working experience in Case Management
Method of Application
If you are qualified and seeking an exciting new challenge, please apply via [email protected] quoting the Job Reference Number and Position by 8th September 2023. Only shortlisted candidates will be contacted.
