CIC Insurance Provider Relations Officer – Microinsurance Jobs in Kenya
About the Role
Reporting to the Assistant Manager Provider & Forensic Management, the role holder will contract medical service providers, act as a liaison between providers and CIC, and ensure service providers operate within agreed contractual terms and standards.
Key Responsibilities
Negotiate fees with new medical service providers covering consultations, procedures, inpatient services and other healthcare costs.
Train service providers on CIC health products, process changes, new schemes, terminated schemes, smart card processes and underwriting rules to improve client service delivery.
Conduct impromptu audits of medical service providers to ensure compliance with CIC rules, procedures, member access requirements and policy exclusions.
Liaise with Sales, Underwriting, Care Management and Claims teams to resolve provider-related issues identified during scheme implementation.
Facilitate the contracting, suspension and termination of providers from the panel based on adherence to agreed terms and conditions.
Negotiate discounts with service providers and coordinate with the Medical Claims and Finance teams to ensure agreed discounts are realized.
Maintain proper documentation of all service provider contracts and ensure contracts remain current and up to date.
Manage the provider network and onboard new providers to meet client access and service requirements.
Address complaints related to service delivery, customer concerns and payment matters involving medical service providers.
Analyze
medical service provider utilization and develop strategies to manage and contain escalating medical costs.
Qualifications
Diploma in Nursing.
Diploma in Insurance is desirable.
Experience
Minimum three (3) years of relevant experience.
Essential Knowledge and Skills
Knowledge of healthcare provider management and medical insurance operations.
Strong negotiation and relationship management skills.
Ability to conduct provider audits and compliance reviews.
Good analytical skills with the ability to assess provider utilization trends and cost drivers.
Strong communication and stakeholder engagement skills.
Ability to manage provider contracts and maintain accurate documentation.
Problem-solving skills and ability to resolve service delivery issues effectively.
Working knowledge of medical claims processes and healthcare service delivery.
How to apply
For more information and job application details, see; CIC Insurance Provider Relations Officer – Microinsurance Jobs in Kenya
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