Provider Relations Analyst Job Britam

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.

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How To Apply

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