Provider Tariff and Resolutions Manager at AXA Mansard

Job Objective:

• Responsible for developing, maintaining, and optimizing tariff structures for all tiers and cadres of partner healthcare providers.
• Negotiate and manage tariffs for hospitals, clinics, and other partner providers to ensure cost-effective, high-quality healthcare services for insured members. Resolve tariff related escalations and ensure cost effective healthcare services for insured members.

RESPONSIBILITIES:

• Develop and implement provider tariff models across all tiers and cadres of provider
• Maintain an up-to-date database of provider tariffs and contracts
• Lead all negotiations with hospitals, clinics, and other providers regarding service rates and update contract terms.
• Ensure tariffs are fair, competitive, and aligned with the organisation’s goals.
• Benchmark against competition’s tariff to ensure efficiency and cost control
• Work in collaboration with the claims team to analyse medical cost trends, claims data, and provider performance to inform tariff adjustments
• Identify areas for cost optimization and value-based pricing opportunities.
• Support provider on-boarding and contract implementation processes.
• Oversee the tariff negotiation team and ensure efficiency in tariff negotiations, appropriate provider tiering and prompt close out of tariff reviews
• Supervise the resolution team to ensure prompt closure of point of care negotiations
• Ensure prompt upload and approval of negotiated tariff on the core business application
• Provide coaching, training, and support to ensure consistent handling and resolution of escalations by the resolution team.
• Act as a liaison between customers, providers, contact centre, and other internal stakeholders to facilitate prompt resolution and approval of pre authorization requests
• Work across the various team to identify the root cause and lead process improvements
• Communicate outcomes clearly and professionally to customers and partners.
• Ensure prompt resolution of all providers and enrollees’ complaints.
• Tracks and monitors all incoming escalations and ensures they are resolved within 24 hours by the appropriate issue owner
• Ensure that healthcare providers comply with the agreement concerning billing and quality of medical care.
• Prepare regular reports on provider negotiations, tariff trends and unit operations
• Assists the unit head on all other operation matters
• Any other duties may be assigned by the unit head

Education/ Professional  Qualification:

• MBBS/MBChB
• Relevant postgraduate (MPH, MSc, MBA) and/or professional qualification would be an added advantage.