Manager, Provider Management, Claims

What the role is?

• Oversee health provider onboarding, including fee negotiation, contracting, accreditation, and conducting briefing sessions for program setup in Hong Kong and China, GBA.
• Collaborate with Third Party Administrators (TPA) to support customer inquiries and the pre-approval process, delivering value-added services.
• Maintain health provider movement to ensure accurate reflection in the vendor search for value-added service programs on customer and distributor platforms.
• Support the Claims team with treatment cost benchmarking through network doctors and assist the Pre-approval team in case follow-ups with panel doctors.
• Conduct regular service level reviews on provider performance, focusing on quality control and collaborating with vendors on process and service enhancements.
• Manage health provider complaints and incidents, ensuring timely resolution within the company’s standard timeframes.
• Assist in developing programs to support product initiatives related to value-added services and claims cost-saving measures.
• Manage program and campaign activities, including provider program setup, communication material preparation, internal and external briefings, and promotional campaigns.
• Conduct surveys with customers and distributors regarding value-added services and programs.
• Oversee the management of the corporate website and customer/distributor platforms related to claims, pre-approval, and provider programs.

What we look for?

• Minimum of 3 years of experience in health provider management.
• Knowledge of doctor network programs and health service delivery.
• Fluent in Mandarin, with excellent communication skills in English.
• University degree in a relevant field.