Provider Tariff and Resolutions Manager

Provider Tariff and Resolutions Manager Location: Lagos

Job Objective

• Responsible for developing, maintaining, and optimizing tariff structures for all tiers and cadres of partner healthcare providers.
• Negotiate and manage tariffs for hospitals, clinics, and other partner providers to ensure cost-effective, high-quality healthcare services for insured members. Resolve tariff related escalations and ensure cost effective healthcare services for insured members.

Responsibilities

• Develop and implement provider tariff models across all tiers and cadres of provider

• Maintain an up-to-date database of provider tariffs and contracts

• Lead all negotiations with hospitals, clinics, and other providers regarding service rates and update contract terms.

• Ensure tariffs are fair, competitive, and aligned with the organisation’s goals.

• Benchmark against competition’s tariff to ensure efficiency and cost control

• Work in collaboration with the claims team to analyse medical cost trends, claims data, and provider performance to inform tariff adjustments

• Identify areas for cost optimization and value-based pricing opportunities.

• Support provider on-boarding and contract implementation processes.

• Oversee the tariff negotiation team and ensure efficiency in tariff negotiations, appropriate provider tiering and prompt close out of tariff reviews

• Supervise the resolution team to ensure prompt closure of point of care negotiations

• Ensure prompt upload and approval of negotiated tariff on the core business application

• Provide coaching, training, and support to ensure consistent handling and resolution of escalations by the resolution team.

• Act as a liaison between customers, providers, contact centre, and other internal stakeholders to facilitate prompt resolution and approval of pre authorization requests

• Work across the various team to identify the root cause and lead process improvements

• Communicate outcomes clearly and professionally to customers and partners.

• Ensure prompt resolution of all providers and enrollees’ complaints.

• Tracks and monitors all incoming escalations and ensures they are resolved within 24 hours by the appropriate issue owner

• Ensure that healthcare providers comply with the agreement concerning billing and quality of medical care.

• Prepare regular reports on provider negotiations, tariff trends and unit operations

• Assists the unit head on all other operation matters

• Any other duties may be assigned by the unit head.

• Education/ Professional Qualification

• MBBS / MBChB

• Relevant postgraduate (MPH, MSc, MBA) and/or professional qualification would be an added advantage.

• Application Closing Date

• Not Specified.