Provider Contract Executive

Provider Contract Executive

District 5 Campus Building B07 Ain Sokhna Road New Cairo 11361 Cairo Egypt Bupa Egypt Insurance SAE

We make health happen

Bupa Global is the international health insurance division of Bupa. We provide customers who want premium international coverage with products and services to access the healthcare they need anytime around the world whether at home or when studying living travelling or working abroad.

Bupa Global has offices around the world including London and Brighton (UK) Dublin (Europe) Miami (USA) Dubai (UAE in partnership with OIC) Egypt and Hong Kong (China) as well as regional offices in mainland China Singapore the Dominican Republic Bolivia Panama Guatemala and Ecuador.

To support the TPA and Network Development managers in Healthcare management in developing improving and maintaining Bupa Globals network of providers in Egypt. You will be supporting research into the relevant approach for the market: direct contracting hospital network access cost management through Third party administrators or other third-party arrangements and to support delivery of the recommended approach through to contract compliance and governance. You will support a portfolio of providers / geographical areas delivering strong network position and cost management through direct contracting or relationships with external partners. You will continually develop improve and maintain Bupas network of providers delivering a differentiated
service proposition for customers and providers quality care and cost management

Howyoullhelp us make health happen

What youll do:

• Prepare and recommend negotiation plans and terms of reference for interaction with third parties in relation to network access and outsourced claims management arrangements. These approaches must be agreed with the Provider Network Development managers and where appropriate the Head of Healthcare management before negotiating activities commence.

• Act as point of referral for provider queries.

• To support the implementation development and maintenance of Bupa Globals provider management strategy for the region ensuring alignment with Bupa Globals proposition development sales and service agenda. Achieve personal targets and develop pipeline for future activity.

• Research availability of quality healthcare provision in target markets and recommend appropriate purchasing and claims spend management approaches through direct contracting network access agreements cost management arrangements through third parties or product structure and policy application rules.

• Support management of provider relationships ensuring delivery of high quality customer focussed and cost-effective healthcare to all Bupa Global members. Ensure that relevant records reflect up to date communications with providers facilitating prompt resolution of enquiries / issues.

• Within target markets review and regularly monitor Bupa Globals claim spend procedures and provider behaviour to ensure that opportunities for additional claims spend management are highlighted. Ensure results are incorporated into quarterly provider or partner review processes and / or annual renewal processes

• Within target markets support execution of strategies to extend provider coverage e.g. to build doctors
  networks with agreed discounts and direct settlement or other inpatient / outpatient direct settlement
  arrangements. Support the development of speciality networks as required.
  Collaborate with other teams within Healthcare Management to contribute to the development of operational
  processes and to monitor operational and financial performance of BGs provider network
  Contribute to development of regular reports around provider management activity.
  Understand comply with and abide by the regulatory requirements of relevant markets within the region
  including but not limited to the Financial Services Authority (FSA) and Financial Ombudsman Service (FOS).
  Conduct ongoing evaluation of relationships through regular meetings and identify opportunities for
  improvement of service and commercial advantage (value for money).
  In conjunction with other members of HCM review and regularly monitor Bupa Globals claim spend in allocated
  markets to ensure that opportunities for additional claims spend management are highlighted.
  Interface with other teams in HCM to ensure that terms and conditions agreed with our service partners and provider network can be implemented and delivered effectively. Obtain feedback and recommendations from our network partners and disseminate this information within Bupa Global

What youll need:

• Bachelors degree or above

• Previous experience preferably in private medical insurance or negotiation

• Perfect command of English both written and verbal. Other languages would be an advantage.

• Strong commercial knowledge of the health insurance industry

• Good commercial negotiation skills

• Ability to deliver projects on time budget and within agreed quality

• Proven track record of achieving targets with a consistent high level of quality

• Ability to work under pressure in a fast-paced environment

• Ability to influence business areas without having direct management responsibility