Vendor Manager

xpatjobs       |    Location:Makati City , Metro Manila       |    Country:Philippines

Job PurposeThe 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 AccountabilitiesKey Results AreaMajor ActivitiesOutputChallenges and RisksOperational oversightSupervise and ensure smooth administration of health insurance by coordinating operational processes for services related to the companys 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 networkClaims administrationService delivery of well-being/health services ( tele-consultation, wellness & prevention programs)Performance metrics and measureQuarterly and annual reportsUpdated SLA/contractManage the balance in vendor relationships in support of the achievement of commercial outcomesCompleteness of documentation and compliance requirementsChallenges in coordination with the process owner (for GHA) due to location or proximityProvide operational support: work with operations (UW, etc.) and front line teams (Branch, Customer Care) to ensure product benefit and service deliveryManagement of processes across the health journeydefine service standards and operating policies towards improving efficiency and quality in delivering customer service; integrate provider services, in-house operations, and governanceContinuously review and evaluate the efficiency and effectiveness of service delivery methods, procedures, administrative and support systems; identify areas of improvement and define implementation strategiesFacilitate escalation and problem resolution, including corrective action planning by vendor for recurring issues or audit findingsTrack, measure, report, and evaluate vendor performance according to contractual obligations and agreed-to service standardsConduct periodic reviews with providers and business units to discuss vendor performance, issues, corrective actions, and anticipated events or changesPut in place tools necessary for measuring vendor / medical specialist performanceManage, liaised with / process or assist in processing of payment of Medical Specialist NetworksAccurate and timely payment of Medical SpecialistCustomer centricityPlan, direct, and spearhead health services initiatives and key partner programsKeep abreast on current healthcare practices, changes in regulations, technology, and customer preferencesCompleted process efficiency projectsPositive customer feedbackContinuity of relationship due to changes in the organization/point-personAppropriate soft skills and customer interaction skillsKey Decisions/DimensionsDecisionsQuantifiable Data Related to JobRecommendatory onlyCompleted SLAs/contracts /process-guidelines reviewRates reduction /improvement On-time / within agreed TAT/SLA resolution of claims SLA achievement by the vendorYour ProfileGraduate in business management, medical, paramedical or other related coursesInsurance risk management or claims management qualifications will be an advantageMinimum 5 years of experience in managing medical / health insurance operations or administration from HMO or insurance companyExperience 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 preferredExpert knowledge of the healthcare insurance market and relevant practices and regulations, and product solutionsPersonal Characteristics/BehaviorsOther RequirementsProven ability to lead project teams with multi-stakeholders in large organization Passion to drive customer mindset Strong understanding of customer experience and logistics in healthcare industry Ability to identify key issues and make recommendations Ability to work well with people of all levels within the organization Knowledge of medical insurance policies, billing policies, and pricing or fee arrangementsConnections with providers in healthcare industry an advantage Excellent communication skills (oral and written), in both one-on-one as well as group scenarios Problem solving, trending, and analysisCertification in Vendor Management or Quality Management (?)Presentation skillsProficiency in MS Office (Word, Excel, PowerPoint)About AXAA global leader in insurance and investments, AXA takes care of 103 million lives in 64 countries worldwide. We actively invest in pioneerin