Provider Relations Officer

Provider Network Relations Officer

Job Summary: Cultivates and optimizes relationships with healthcare providers in the assigned area, ensuring an effective network that delivers high quality care to HMO members.

Job Responsibilities:

Financial Management

1. Meet the set targets consistently and assists the section head in ensuring the section's expenses are within budget to contribute to the department's overall financial performance.
2. Contributes to the management of the department's loss ratio by strictly adhering to the established provider standards and guidelines of the department and when evaluating and accrediting new providers or renewing existing providers to ensure that only the desired and profitable partnerships form part of the department's and Pioneer's provider network.

Experience Management

1. Executes service delivery processes and activities with precision and efficiency, adheres to SLAs, identifies potential bottlenecks in the process, and suggests improvements to enhance customer and provider experiences.
2. Maintains open communication with clients, partners, and colleagues, proactively contributes to problem-solving, and fosters a positive and collaborative work environment to establish and maintain positive customer and provider experiences.

Process Management

1. Delivers the following processes and activities consistently according to agreed-upon quality standards and turn-around time
2. Actively contributes to policy and guideline discussions, offering insights and recommendations based on their expertise and experience.
3. Analyzes raised concerns within their area of expertise, resolves them independently when possible, and escalates complex issues to ensure Service Level Agreements (SLAs) are met

Data Management

1. Complies with data and document management standards and procedures in handling documents and data, as well as help junior team members on document management best practices, to ensure the accuracy and completeness of the team's records and databases.
2. Produces accurate and timely reports according to specifications while observing the SLA and the data and document management standards and guidelines.

Job Qualifications:

College Graduate (BS Nursing, Psychology, etc.)

With at least 3 years experience on the same role (Healthcare)

Proficient in the use of Microsoft Office tools

With excellent attention to detail, Organizational Savvy and Results oriented

Must be willing to work in CDO City (Hybrid)