Provider Network Manager

1 month ago

Riyadh, Saudi Arabia The Cigna Group Full time
The job profile for this position is Business Project Lead Analyst, which is a Band 3 Senior Contributor Career Track Role.

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Our people make all the difference in our success.

To establish and manage operationally the provider relations planning and strategic agenda to deliver the claims cost optimization targets/objectives .To review claims adjudication by the TPA and co ordinate with providers to maximize the claims settlement in line with target. 

Key Activities / Decision Areas

  • Establish operational plans at a granular level (regional/ network and provider level) to deliver claims settlements, fraud recoveries , unit cost  management and price increase management in line with the company contribution objectives.

  • Monitor and manage dynamically adherence to plan on a weekly bucket and at a granular level to deliver our plans in line with the company contribution objectives.

  • Identify new opportunities and initiatives to continuously drive risk cost management at diagnostic and service level, this will include volume allocation to providers based on their unit cost.

  • Control risk cost, bend the claims curve and utilization/volume by creating a new funding model and efficient trading terms.

  • Build a competitive service strategy to include value for money, hassle free service, VIP management, access to best advise/care.

  • Promote quality of healthcare by monitoring conversion/readmission rates, LOS, medical outcome, preventative healthcare.

  • Collaborate with providers to drive telehealth and health campaigns

  • Integrated with providers systems for more transparent relationship.

Skills & Experience required:

  • Minimum 5 years experience working with Providers within KSA

  • Bachelorâs Degree in Information Science and Technology, Business Administration or related discipline is required, MBA preferred

  • Knowledge of health care and/or insurance industry is preferred

  • Knowledge of process design, measurement techniques and governance frameworks required

  • Experience of managing supplier relationships across multiple countries on a global basis

  • Demonstrated and applied experience initiating and successfully delivering complex projects

  • Excellent problem-solving and strategic thinking skills

  • Ability to navigate a fast paced, highly matrixed organization effectively

  • Ability to remove barriers and enable teams to complete their objectives

  • Proven ability to present and communicate at all levels with clarity and precision both written and verbally

  • A proven ability to quickly earn the trust of sponsors and key stakeholders; mobilize and motivate teams; set direction and approach; resolve conflict; deliver tough messages with grace; execute with limited information and ambiguity

  • Cultural competency, organizational skills, negotiation skills and customer focus

  • Strong skills using Microsoft Office Suite (Word, Excel, PowerPoint, SharePoint, etc.)

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.

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