Provider Relations Operation Manager
Bupa Arabia
Total des années d'expérience :23 years, 0 Mois
Managed professionally the commercial and contractual relation with Bupa Arabia network providers to assure the compliance of regulation and the delivery of business benefit.
Analysed, monitor the cost effectiveness of the unit and utilization of services of the providers to control and drop the it year after year.
Achieved providers better discount / prices reduction.
Assure to settle the provider accounts by 90% within the end of year.
Support networking team and commercial team to plan for forecasting.
Acceptance of insurance card and payment terms with 180 providers throughout Riyadh Market. (with total cost above 230 million SR)
Developed and implemented provider classification and ranking formula to contain the medical risk.
Renewal of the Contracts & terms and negotiations with 65 providers, helping to control loss ratio
Contracting with 60 new agreement of providers, including four of NGHA hospitals.
Achieved highest result 2.7 M in terms of reconciliation above target.
Report to National Provider Relations Manager
Escalate the critical problems to provider relation director.
Handled more than 100 providers (with total cost 80 millions SR)
Contain medical cost through achieving a certain percentage of shortfall excluding prompt payment and volume discounts agreement.
Use the previous experience to achieve the target and above the target of the medical shortfall.
Work with providers to improve our member’s experience when receiving treatment at any of Bupa approved providers.
Negotiate with provider regarding cost, new agreements, renewal of contracts.
Build effective and efficient partnership relations with our providers and lobby with them to grant a best performance award in Riyadh and central Province.
Provide logistic support across all units within the department and extends its support to other related departments.
Analyse provider issues and coordinate with providers to arrive at amicable resolution.
Communicate with the providers to solve out, payment issues, Clint issues, agreement conditions.
Manage, organise and update relevant data using database application to ensure integrity of reference data.
Organize the work and give support to relationship team.
Track record in handling complicated tasks in the department, which is already meant to be handled by the mentors and team leaders (Fraud- Anti selection cases).
Providing quality customer service on every incoming & outgoing call. (Classified as No. 1 achiever based on Best Quality in November 2008).
Insure that all written and verbal complaints are being handled according to the complaint handling process.
Follow up and use proper escalation with / to other departments for proper resolution related to complex cases.
Taking the leadership of handling critical issues provided by the direct & the processing manager.
This was my first experience to run my own business. I was importing industrial equipments, maintaining convenient stock, and selling the product to the retailers and wholesalers.
Processing of all accounts receivable and payable
Reconcile bank balances, record general ledger entries
Collecting due payments from client
Establish customer credit lines and set up credit accounts with vendors
Performed general sales, Marketing and Promotional tasks
Formulated contracts with vendors and client Organized and controlled inventory
Performed purchasing duties
Collecting due payments from client
Graduated