Job Purpose:

The Provider Relations Analyst will play a crucial role in analyzing and managing the relationships between the insurance company and healthcare providers.
This position involves evaluating medical service provider data, ensuring compliance with policies and regulations, and optimizing provider networks to enhance service delivery and operational efficiency.

Key responsibilities:

Analyze service provider data to identify trends, patterns, and areas for improvement.
Prepare and present detailed reports on provider performance, utilization, and cost-effectiveness.
Develop and maintain dashboards and metrics to track key performance indicators (KPIs).
Evaluate and assess the performance of service providers to ensure adherence to company standards and contractual agreements.
Collaborate with network managers to optimize provider networks and improve provider relations.
Conduct regular audits and reviews of provider services and billing practices.
Ensure compliance with regulatory requirements, company policies, and industry best practices.
Monitor and address any discrepancies or issues related to provider billing, claims, and documentation.
Assist in the development and implementation of quality assurance programs for provider services.
Identify opportunities for process improvements and implement solutions to enhance efficiency and effectiveness.
Develop and recommend best practices for managing provider relationships and optimizing service delivery.
Delegated Authority: As per the approved Delegated Authority Matrix.

Key Performance Measures:

As described in your Personal Score Card.

Knowledge, experience and qualifications required

Bachelor’s degree in actuarial science, Statistics, Mathematics or a related field.
Minimum of 2 years of experience in healthcare analysis, insurance, or a related field.
Strong understanding of medical terminology, healthcare systems, and insurance processes.
Proficiency in data analysis tools and software (e.g., Excel, SQL, or BI tools).
Excellent analytical, problem-solving, and critical-thinking skills.
Strong communication and interpersonal skills with the ability to interact effectively with diverse stakeholders.

Technical/ Functional competencies:

Knowledge of insurance regulatory requirements.
Knowledge of insurance products.
Sales and marketing management skills.