Network Manager – Insurance

𝐉𝐎𝐁 𝐒𝐔𝐌𝐌𝐀𝐑𝐘
As a Network Manager, you will play a crucial role in managing and optimizing relationships with the network of healthcare providers. This role presents an exceptional opportunity for a strategic professional to make significant contributions to the success and expansion of the business.

𝐐𝐔𝐀𝐋𝐈𝐅𝐈𝐂𝐀𝐓𝐈𝐎𝐍𝐒, 𝐒𝐊𝐈𝐋𝐋𝐒 & 𝐄𝐗𝐏𝐄𝐑𝐈𝐄𝐍𝐂𝐄:
1. Graduate preferable in Medicine
2. Minimum 8 years of experience
3. Proficient in communication, negotiation, and persuasion.
4. Demonstrates outstanding customer care and interpersonal skills.
5. Possesses strong team management and leadership capabilities.
6. Effective presentation skills.
7. Exhibits attributes such as customer focus, analytical thinking, decision-making, problem-solving, emotional intelligence, critical thinking, and a commitment to values and ethics.
8. Proficient in office applications, including MS Word, Excel, and PowerPoint.

𝐉𝐎𝐁 𝐑𝐄𝐒𝐏𝐎𝐍𝐒𝐈𝐁𝐈𝐋𝐈𝐓𝐈𝐄𝐒:
1. Develop and align department objectives with overall business goals for effective strategic implementation.
2. Ensure quality customer service by fostering relationships with service providers.
3. Provide updated network lists to business partners in line with policy guidelines.
4. Manage contract renewals and negotiations, incorporating strategic approaches for optimal outcomes.
5. Coordinate contracting processes, ensuring cost-effective services with healthcare providers.
6. Cultivate relationships with payers, physicians, employers, regulators, members, and facility providers.
7. Identify and onboard new healthcare providers, enhancing network advantages.
8. Conduct presentations and training on managed care concepts and service requirements for healthcare provider staff.
9. Orient healthcare provider personnel on insurance concepts, procedures, and regulatory requirements.
10. Coordinate resolution of provider claims and capitation issues.
11. Review and provide recommendations on policy manuals and network agreements.
12. Implement quality assurance programs to maintain service standards and minimize fraudulent cases.
13. Ensure timely payments to network providers.
14. Document business decisions and processes professionally.
15. Maintain open communication, set clear team goals, monitor performance, and foster a collaborative team environment.