FIND YOUR BETTER AT Blue Care
If you believe in better, we'd love to hear from you.
About the Role
Responsible to assist in establishing the strategy, creation, direction and evolution of the provider network. The incumbent will liaise with providers and conduct ongoing evaluation of network performance so as to ensure a complete, stable, accessible well-regarded and high-quality delivery system.
This role contributes to the delivery of customer outcomes that are reliable, thoughtful, and create meaningful impact for customers and society. The role holder is expected to embed a customer first mindset in all decisions and actions by developing a clear understanding of customer needs, taking end to end ownership to resolve issues, and working collaboratively across teams to continuously enhance the customer journey-both directly and indirectly.Roles and Responsibilities:
Setup and maintain provider network:
Initiate and maintain network provider for health services.
Administer credentialing process and operation of network provider.
Establish working procedure and identify control process for compliance to service standards.
Accomplish the requirement for panel network to perform eligibility check and EDI claims submission for accuracy and efficiency.
Conduct briefing/training to internal staff.
Attend panel meeting / facility visits for ensuring accuracy in panel system setup and administration.
Setup and maintain network provider data in system for eligibility check, provider information display, prior authorization and claims processing.
Review system performance and identify areas for technical support team to monitor for stability.
Execute manual support for maintaining customer satisfaction during system stoppage or slow response due to technical issue.
Review network provider quality:
Review on network provider to identify areas for improvement.
Provide recommendations to network providers after investigation of reported servicing issue.
Monitor network providers performance within the established service standard.
Conduct regular meeting with Panel Network for utilization review and service excellence.
Identify problems which affect the Network and proactively communicate with management.
Maintenance on business services:
Coordinates with different teams to maintain the service standard to our clients.
Assist on the business renewal and support on RFP/ tender requirement
Assist on individual product design requirement
Manages the service arrangement for health talks, check-up or onsite biometric assessment to clients
Other duties and responsibilities:
Assist to coordinate health care related services for enhancing customer satisfaction.
Participate in projects relating to service enhancement or new business initiatives arise.
You are required to obtain relevant license if your job involves in regulated activities
Other duties and responsibilities as assigned by supervisor.
Minimum Job Requirements:
University Degree in Business Studies, Health Administration or relevant disciplines.
Minimum 6-8 years relevant experience with at least 5 years in healthcare industry.
Registered nurse is preferred.
Customer service and presentation experience required.
Strong business communication, analytical, problem solving, documentation and organizational skills.
Knowledge of Healthcare billing and medical terminology.
Strong business analytical, documentation and organizational skills.
Proficient in both spoken and written Chinese and English.
Strong communication and negotiation skills.
The incumbent is required to obtain relevant license if the job involves in regulated activities.
