Provider Relations Specialist (Remote)

PROVIDER RELATIONS SPECIALIST (Part-time Position)

SEND YOUR CV TO:

• recruitment@inovacare.com

Inova Care is a dynamic and growing Third Party Administrator (TPA) specializing in cost containment and delivering high-quality TPA services across a range of insurance sectors, including medical, dental, pet insurance, and healthcare. Operating across Southeast Asia and the United States, we provide an extensive provider network, claims adjudication, customer service, and specialized TPA services for the medical insurance industry in Asia.

While our team is lean and highly agile, we are committed to delivering exceptional service with a big impact. We are seeking a passionate and experienced Provider Relations Specialist professional who possesses strong communication and interpersonal skills, attention to detail, an understanding of healthcare regulations, and the ability to build and maintain positive relationships with healthcare providers. They must also be adept at problem-solving, negotiation, and ensuring compliance with organizational policies and industry standards.

Responsibilities

• Perform a SWOT Analysis, lead the execution of a detailed SWOT analysis to uncover the strengths, weaknesses, opportunities, and threats associated with the recruitment of clinics and hospitals into the cashless partnership program to formulate recruitment strategy.
• Develop a targeted list of providers for recruitment and prioritize based on type of provider and geography.
• Focus on identifying and addressing gaps in geographic coverage, provider incentives, and competitive positioning to increase network attractiveness and provider satisfaction.
• Analysis of provider network for adequacy in addressing access requirements, as well as the identification and recruitment of new providers to meet certain geographic or care needs.
• Recruit, contract, and maintain relationships with clinic, hospitals and ancillary care providers.
• Manage key provider relationships (including problem solving) to ensure a positive collaboration with the company.
• Work to ensure the quality of the provider network, as well as quality of all products and services offered by the company.
• Conduct provider orientations, provider education forums and site visits to ensure that network providers are knowledgeable of Inova Care products, operating procedures, and services.
• Research and resolve misapplied claim payments or provider reimbursements.
• Collaborate with medical statistics unit and other company departments as required regarding the development and implementation of provider fee schedules.
• Ensure that company’s provider network recruitment and provider retention targets are satisfied.
• Weekly and monthly reports regarding provider network development and management activities.
• Support the company’s provider network goals and objectives regarding clinical pathways.
• Other tasks as assigned by the company related to support the company’s growth, revenue and provider network objectives.

Key Qualifications:

• Male/ Female
• Able to speak English
• Minimum 3-year experience as a Provider Relations in Insurance/ TPA company
• Has excellent communication skills
• Has negotiation, presentation, and administration skills
• Service and solution oriented
• Has strong problem-solving skills and analytical abilities
• Able to prioritize tasks and multi-task
• Able to work under pressure and complete targets.
• Familiar with the legal aspects of the cooperation agreement process
• Must be able to work independently and with minimum supervision
• Self-motivated and shows initiative
• Willing to travel internationally if needed
• Can be available to take full-time hours as needed