Provider Management Officer

About the role

The Provider Management Officer will oversee the management, contracting, accreditation, and audit processes for service providers within the Heritage Insurance network. This role ensures high‑quality, cost‑effective healthcare services for insurance members.

Key responsibilities

• Maintain cordial relationships with existing providers in the network.
• Accredit new service providers to meet client needs and regulatory standards.
• Negotiate service fees based on Heritage Insurance rates and market norms.
• Coordinate and conduct provider audits to verify service quality.
• Enforce compliance with Heritage policies on member access, exclusions, and panel rates.
• Collaborate with Underwriting/Actuarial to produce monthly utilization reports and implement cost‑containment measures.
• Document contracts, manage renewals, and update KYC information per guidelines.
• Train providers on Heritage service access procedures and policy updates.
• Negotiate discounts, reconcile finances, and resolve provider‑related issues with internal teams.
• Maintain and regularly update the provider panel, sharing information with stakeholders.

Required profile

• Bachelor’s degree or Diploma in Nursing, Clinical Medicine, Pharmacy, or a related medical discipline.
• Minimum 3 years of experience in provider relations within medical insurance, hospitals, or related sectors.
• Strong communication, negotiation, and analytical abilities.
• Good understanding of provider dynamics, cost‑optimization strategies, and insurance processes.

Required skills

• Excel
• MS Office