RELIANCECARE INC.
Provider Network Manager
1 month ago
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Important information
Contract type:
Permanent
Location:
Mandaluyong City, Metro Manila, Philippines
Work mode:
Onsite
Published on:
17 September 2026
What they need
About the role
To provide end-to-end medical, operational, and strategic oversight across claims adjudication, provider management, accreditation, and internal medical support—serving as a critical bridge between Clinical, Customer Service, Finance, and Provider Networks.
Key responsibilities
- Lead provider engagement initiatives (planning, organizing, and execution)
- Approve/deny reconciliation of accounts impacting provider payments
- Perform in-patient adjudication, including proper segregation of illnesses
- Review and approve facility accreditation and any changes
- Handle and resolve Customer Service medical concerns and escalations
- Review and evaluate contracts (providers)
- Screen, accredit, and onboard CCM and clinic management doctors
- Monitor PROs' KRAs and overall performance
- Provide real-time medical guidance to CSRs
- Analyze utilization data and provide strategic recommendations to management
About you
- Licensed physician with a strong background on health insurance, HMO or related field
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