Senior Executive Provider Network Management

About the role

The Senior Executive, Provider Network Management will independently manage assigned healthcare providers and support the performance, governance and continuous improvement of ProtectHealth’s provider network.

The role covers the provider lifecycle, performance monitoring, provider engagement and operational issue resolution, while supporting cost containment, care outcomes and Fraud, Waste & Abuse (FWA) initiatives through data analysis and cross-functional collaboration.

Key responsibilities

• Manage provider empanelment, credentialing, onboarding, renewal, suspension and termination activities.
• Manage an assigned portfolio of healthcare providers and maintain effective provider relationships.
• Monitor provider performance against KPIs, SLAs, contractual requirements and service standards.
• Analyse provider performance, utilisation and operational data to identify trends, gaps and areas for improvement.
• Coordinate provider performance reviews and follow up on corrective and improvement actions.
• Manage provider enquiries, operational issues and escalations within the assigned portfolio.
• Support healthcare cost-containment and FWA monitoring initiatives.
• Support provider contract administration, renewals, amendments and compliance monitoring.
• Prepare provider performance reports, analyses and recommendations for management.
• Support provider audits, compliance reviews and governance activities.
• Participate in process improvement, automation and digitalisation initiatives.
• Work closely with internal stakeholders, healthcare providers and relevant partners to support effective service delivery.

What we're looking for

• Bachelor’s Degree in Healthcare Management, Medicine, Pharmacy, Nursing, Allied Health, Business Administration, Health Administration or a related discipline.
• Approximately 4–7 years of relevant working experience within healthcare, hospitals, health insurance, managed care, TPA or provider network environments.
• Relevant experience in provider/panel management, provider relations or healthcare operations.
• Experience in provider empanelment, credentialing, performance monitoring or contract administration would be highly advantageous.
• Exposure to healthcare cost containment and/or Fraud, Waste & Abuse (FWA) would be an advantage.
• Experience working with provider performance, utilisation or healthcare operational data.
• Strong analytical, problem-solving, stakeholder management and communication skills.
• Exposure to patient/care outcome management or analysis would be an added advantage.