Executive Provider Network Management

About the role

The Executive, Provider Network Management supports the day-to-day management, coordination and monitoring of ProtectHealth’s healthcare provider network.

The role is responsible for supporting provider empanelment, credentialing, onboarding, performance monitoring and engagement, while ensuring accurate provider documentation, timely follow-up and compliance with established requirements.

The incumbent will work closely with healthcare providers and internal stakeholders to support an efficient, responsive and well-governed provider network.

Key responsibilities

• Coordinate provider empanelment, credentialing, onboarding, renewal and other provider lifecycle activities.
• Review provider submissions and supporting documentation against established requirements.
• Maintain accurate and up-to-date provider records, agreements and related documentation.
• Monitor provider performance against established KPIs, SLAs and service requirements.
• Track provider issues, complaints and corrective actions and ensure timely follow-up.
• Handle routine provider enquiries and operational matters and escalate significant issues where required.
• Coordinate provider communications, meetings, briefings and engagement activities.
• Assist in compiling and reviewing provider utilisation, cost and performance information.
• Support healthcare cost-containment and Fraud, Waste & Abuse (FWA) monitoring activities.
• Assist with provider contract administration, compliance reviews and audit-related activities.
• Prepare provider reports, trackers and operational updates.
• Support process improvement, digitalisation and other provider network initiatives.

What we're looking for

• Bachelor’s Degree in Healthcare Management, Medicine, Pharmacy, Nursing, Allied Health, Business Administration, Health Administration or a related discipline.
• Minimum 2–4 years of relevant working experience within the healthcare industry, preferably in hospitals, health insurance, TPA, managed care or provider network management.
• Relevant experience in provider/panel management, provider relations, healthcare operations, medical administration or healthcare claims is preferred.
• Exposure to provider empanelment, credentialing, onboarding or performance monitoring would be advantageous.
• Exposure to healthcare cost containment, FWA, provider utilisation or provider performance monitoring would be an added advantage.
• Comfortable working with healthcare-related data, reports and provider documentation.
• Strong communication, stakeholder coordination, problem-solving and attention-to-detail skills.
• Able to independently manage assigned responsibilities and follow through on operational matters.