PURPOSE OF ROLE:

• Responsible for the provider relationship management in allocated geographical area both Commercially and Medically to ensure delivery of Quality care for AXA Customers at competitive commercial terms

KEY TASK OVERVIEW (amongst others): You will:

• Develop Medical Provider Relations and building relations with key stakeholders in assigned medical providers.
• Develop Provider Networks to meet customer and business needs through expert knowledge of market providers.
• Negotiate commercially beneficial terms for AXA with Providers.
• Assist and help in medical complex cases to ensure proper medical case management for the insured members and negotiates discounts on same.
• Implement procurement strategic action plans and communicate identified issues for agreement on resolution actions.
• Conduct Provider Quality and suitability assessments for Network Inclusion/Exclusion or Network categorization changes.
• Implement Investigations and Audit strategic action plans supporting FWA activity- 10% of time allocated.
• Monitor provider billing and utilization behaviors to identify opportunities for improvements to clinical practice and billing
• Review existing contract terms to identify areas for improvement on commercial terms and operational efficiency
• Support reconciliation activity.
• Ensure compliance with legal and regulatory requirements, represents AXA as required with external regulatory/ Health organizations.
• Enhance customer experience as part of AXA Strategy ‘Payer to Partner’.
• Provide guidance and expert medical direction to the medical claims teams, insurance departments of the medical providers.• Represent AXA effectively both in front of providers as well as customer.
Skills

MINIMUM TECHNICAL & BEHAVIORAL COMPETENCY CRITERIA:

• Extensive knowledge of the Country’s healthcare Insurance market, GCC countries healthcare provider’s trends and behaviors, and GCC countries legislations and regulations.
• Sound medical knowledge, insurance claims adjudication, all medical insurance policies, billing policies and pricing / fee arrangements.
• Expert knowledge of medical conditions, treatments and procedures in order to guide claimants and challenge medical practitioners and healthcare providers.• Extensive connection with Healthcare providers in GCC countries.


Academic Qualifications:
• Medical Degree is required (MBBS or MBChB or MBBCh).• Have at least 3 years work experience in healthcare insurance field.


Job Details

Job Location: Dubai, United Arab Emirates Company Industry: Insurance Company Type: Employer (Private Sector) Job Role: Management Employment Type: Full Time Employee Monthly Salary Range: Unspecified Number of Vacancies: 1 Job Ref.: JB3737679
Preferred Candidate

Career Level: Management Residence Location: United Arab Emirates Degree: Bachelor''s degree / higher diploma