Head of Insurance

2 days ago

Jeddah, Makkah Province, Saudi Arabia Combuzz HR Solutions Full time

Job Title:
Manager – Medical Provider Network

Location:
Kingdom of Saudi Arabia

Scope:
Saudi Arabia with future GCC expansion

Reporting To:
Chief Executive Officer

Role Overview

We are seeking an experienced Manager – Medical Provider Network to design, build, and expand a high-quality, cost-effective medical provider network across Saudi Arabia, with a scalable framework to support future GCC expansion.

This role will focus on direct provider contracting, cost management, clinical quality, utilization strategy, and long-term relationship management with hospitals, insurers, TPAs, laboratories, and rehabilitation centers.

Key Responsibilities

Provider Network Strategy & Design

  • Develop and implement a tiered provider classification model
  • Define utilization strategies aligned with cost, acuity, and quality objectives
  • Build a balanced network covering tertiary, secondary, and community providers
  • Ensure strong geographic coverage across major and secondary cities in Saudi Arabia

Direct Contracting & Commercial Negotiation

  • Lead direct negotiations with Class A, B, and C hospitals
  • Negotiate pricing structures, discounts, SLAs, and governance frameworks
  • Establish volume-based and utilization-linked commercial terms
  • Reduce dependency on intermediaries while maintaining effective TPA coordination

Insurance & Payer Partnerships (Medical Assistance)

  • Identify, approach, and contract insurers, reinsurers, TPAs, and corporate payers
  • Position the organization as a preferred medical assistance partner for local and international cases
  • Negotiate service agreements, referral frameworks, pricing models, and SLAs
  • Drive sustainable case volumes and revenue growth

Provider Relationship & Performance Management

  • Maintain senior-level relationships with hospital leadership, finance, and billing teams
  • Monitor provider performance, compliance, and service quality
  • Ensure long-term partnership stability

Network Integration & Expansion

  • Oversee integration with TPAs, diagnostic laboratories, and rehabilitation centers
  • Align approvals, billing coordination, and administrative processes
  • Support insurer and corporate client requirements

Qualifications & Experience

  • Medical degree, healthcare management qualification, or equivalent senior healthcare background
  • 10+ years of experience in provider contracting, medical networks, insurance, or medical assistance models
  • Strong relationships within Saudi hospitals, insurers, TPAs, and healthcare stakeholders
  • Proven negotiation experience with major hospital groups
  • Strong understanding of clinical governance, utilization management, and cost control
  • Willingness to travel across Saudi Arabia and the GCC

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