Provider Relations Officer

Heritage Insurance is an insurance company that provides various insurance products, including health insurance, and is part of the Liberty Kenya group.

The role holder will be responsible for service providers management, contracting, accreditation and audits.

1. Maintain a cordial working relationship with providers within the Heritage Insurance provider network
2. Accredit new service providers to meet the client’s needs/demands
3. Negotiate service fees upon contracting of new service providers, guided by the Heritage Insurance rates and customary fees
4. Coordinate provider audits to ensure quality services are accessed by Heritage Insurance clients
5. Enforce compliance to Heritage rules and procedures regarding member access, policy exclusions and panel rates
6. Coordinate with Underwriting/Actuarial & prepare monthly utilization report on performance of service providers and develop appropriate measures to contain cost
7. Proper documentation of all service provider contracts and ensure timely renewal and KYC updates as per the set guidelines
8. Train Service providers on Heritage Insurance service access procedure/processes, update on any changes at Heritage Insurance in term of health products, existing processes and other related claim policies
9. Engage service providers in negotiation for discounts and close finance reconciliations
10. Liaise internally with other sections to ensure resolution of service provider related issues
11. Regular update of the Heritage Insurance provider panel and timely sharing with relevant stakeholders

1. Bachelor’s degree/Diploma in Nursing, Clinical Medicine, Pharmacy, or medical – related discipline
2. At least 3 years’ experience in provider relations in medical insurance, hospital or related industry
3. Excellent communication and negotiation skills
4. Good analytical skills
5. Computer literate in MS Office and excel applications
6. Good knowledge of provider dynamics and landscape
7. Cost Optimization strategies