Vendor Senior Manager

14 hours ago

Makati City, National Capital Region, Philippines AXA Philippines Full time

Job Purpose

The role is responsible for planning, directing, and coordinating the medical and health services of the company (function or processes) including management of TPA relationship for hospital network development, management of network of medical specialist, review of processes, and engagement of new partners and processes for medical health services.

Provide assistance, hospital / clinic / doctor coordination during our-patient, in-patient or emergency room (ER) consultations/admissions of client, as may be needed.

Provide assistance to Claims Director/ Claims Head as may be required / needed.

Critical Accountabilities

  1. Supervise and ensure smooth administration of health insurance by coordinating operational processes for services related to the company's medical portfolio, including arranging and managing TPA partnership or network of medical specialist or relevant service partners for identified critical points across the health journey, including but not limited to:
  • Access to medical network
  • Claims administration
  • Service delivery of well-being/health services (e.g. tele-consultation, wellness & prevention programs)
Provide operational support: work with operations (UW, etc.) and front line teams (Branch, Customer Care) to ensure product benefit and service delivery.Management of processes across the health journey—define service standards and operating policies towards improving efficiency and quality in delivering customer service; integrate provider services, in-house operations, and governance.Continuously review and evaluate the efficiency and effectiveness of service delivery methods, procedures, administrative and support systems; identify areas of improvement and define implementation strategies.Facilitate escalation and problem resolution, including corrective action planning by vendor for recurring issues or audit findings.Track, measure, report, and evaluate vendor performance according to contractual obligations and agreed-to service standards.Conduct periodic reviews with providers and business units to discuss vendor performance, issues, corrective actions, and anticipated events or changes.Put in place tools necessary for measuring vendor / medical specialist performance.Manage, liaise with / process or assist in processing of payment of Medical Specialist Networks.Plan, direct, and spearhead health services initiatives and key partner programs.Keep abreast on current healthcare practices, changes in regulations, technology, and customer preferences.

Educational Qualifications

  • Graduate in business management, medical, paramedical or other related courses.
  • Insurance risk management or claims management qualifications will be an advantage.

Relevant Experience

  • Minimum 5 years of experience in managing medical / health insurance operations or administration from HMO or insurance company.
  • Experience in setting up and/or managing operations processes supporting medical or HMO products, managing networks of Medical Specialist.
  • Experience in claims management and/or medical background preferred.
  • Expert knowledge of the healthcare insurance market and relevant practices and regulations, and product solutions.

Other Requirements

  • Certification in Vendor Management or Quality Management (?).
  • Presentation skills.
  • Proficiency in MS Office (Word, Excel, PowerPoint).
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