Middle East Jobs, Careers, Vacancies: Manager - Provider Relations Operations, Bupa Arabia, Riyadh, KSA

Manager - Provider Relations Operations, Bupa Arabia, Riyadh, KSA

Job Description

Set the targets aligned with the overall forecast.
Analyze, monitor the cost effectiveness of the unit and utilization of services of the providers to control and drop it year after year.
Plan for reconciliation meetings, this will include scheduling meetings, coordination with medical manager, preparation of financial figures and negotiation tools
Negotiate the reconciliation with the providers to achieve the set targets
Document the reconciliation facts and send feedback to the claims department and regional manager
Prepare presentation to the owners of top 20 provider, at least once/year to highlight the trends and errors
Ensure that the reconciliation is conducted on regular basis and in line with the CCHI regulations
Review and maintain the existing and renewed contracts to identify and resolve issues that ensure better commercial terms and improve operation
Establish good relationship with new providers and assess the integration to Bupa network by comparing their prices to in network hospitals taking into consideration the providers’ location and the geographic distribution of the members.
Set the targets aligned with the overall forecast
Improve the commercial trading terms by negotiating and signing up better prices and discounts to guarantee that Bupa will achieve the price reduction targets set on annual basis.
Prepare the proposals for better prices and discount structures of the frequent services and package in coordination with the commercial team and medical manager
Negotiate and agree with the providers for better prices
Intimate the agreements to the commercial and support team for uploading and implementation
Negotiate better deals for the identified high value claims on real time basis before sending the claims
Monitor the compliance of the providers with the agreements on their claim’s presentation
Plan, coordinate and carry regular visits to the providers to maintain with them professional relationship.
Follow up by phone and with written correspondences on issues raised during negotiation with providers.
Identify the unfavorable trends in medical practice of the providers
Manage the delivery of training session and development programs to providers’ staff on Bupa new systems, policies, and procedures.
Keep continuous relation with other medical team in the business including the hospital auditing doctors.
Attend to members and providers complaints on medical issue