Provider Relations Analyst – (2400003J)
Job Purpose and Key responsibilities
Job Purpose:
- The Provider Relations Analyst will play a crucial role in analyzing and managing the relationships between the insurance company and healthcare providers.
- This position involves evaluating medical service provider data, ensuring compliance with policies and regulations, and optimizing provider networks to enhance service delivery and operational efficiency.
Key responsibilities:
- Analyze service provider data to identify trends, patterns, and areas for improvement.
- Prepare and present detailed reports on provider performance, utilization, and cost-effectiveness.
- Develop and maintain dashboards and metrics to track key performance indicators (KPIs).
- Evaluate and assess the performance of service providers to ensure adherence to company standards and contractual agreements.
- Collaborate with network managers to optimize provider networks and improve provider relations.
- Conduct regular audits and reviews of provider services and billing practices.
- Ensure compliance with regulatory requirements, company policies, and industry best practices.
- Monitor and address any discrepancies or issues related to provider billing, claims, and documentation.
- Assist in the development and implementation of quality assurance programs for provider services.
- Identify opportunities for process improvements and implement solutions to enhance efficiency and effectiveness.
- Develop and recommend best practices for managing provider relationships and optimizing service delivery.
- Delegated Authority: As per the approved Delegated Authority Matrix.
Key Performance Measures:
As described in your Personal Score Card.
Knowledge, experience and qualifications required
- Bachelor’s degree in actuarial science, Statistics, Mathematics or a related field.
- Minimum of 2 years of experience in healthcare analysis, insurance, or a related field.
- Strong understanding of medical terminology, healthcare systems, and insurance processes.
- Proficiency in data analysis tools and software (e.g., Excel, SQL, or BI tools).
- Excellent analytical, problem-solving, and critical-thinking skills.
- Strong communication and interpersonal skills with the ability to interact effectively with diverse stakeholders.
Technical/ Functional competencies:
- Knowledge of insurance regulatory requirements.
- Knowledge of insurance products.
- Sales and marketing management skills.