Head of Medical Network

Tandem Search

Dubai, UAE

Ref: KP709-1838

Job description / Role

Employment: Full Time

Take the lead in securing commercial and competitive contract terms with quality suppliers of medical services (routine and emergency) across the Middle East and Africa region.

In conjunction with the Heads of Clinical Services and Head of Claims, ensure consistent delivery of medical care and services throughout the Companys regional provider network, both proprietary and via Third Party Administrators (TPAs), so that our members receive health care of the highest quality while our plans and benefits are utilised in a cost-effective and sustainable manner.

Deploy the strategies needed to support our growth, including driving highly commercial and competitive contract terms with all providers.

Oversee proper functioning of day-to-day Network operations. Work with the Service Delivery Director to continually improve the customer experience.
The role is a key driver in ensuring appropriate utilisation of our plans with a direct capacity to influence our loss ratio and thereby the long-term profitability of our Company.

The capacity to provide leadership, facilitate change and achieve objectives while recognising and accommodating the differences across our regional markets critical to the success of this role.

- Develop and implement a Network Management strategy to deliver financial savings via discount structures and volume rebates. Continually improve network management techniques in order to drive down spend.
- Develop and agree annual Network Management cost savings targets and ensure these targets are achieved.
- Proactively research, understand and document the market landscape in order to provide specialist advice and guidance on leading network management practices to the senior management team. Present options for provider sourcing strategies and take the lead in identifying, assessing and managing the potential risks associated with the selected approach.
- In conjunction with the Head of Clinical Services, conduct a full review of existing agreements with networked hospitals, clinics and agreed TPAs to enhance the direct billing network, optimize costs and ensure commercial viability of terms. Ensure that rates and services are agreed at the most competitive prices and timescales possible and delivered as such.
- Define, manage and maintain key supplier relationships across the medical network to deliver breakthrough performance in cost, service and quality, including technical input to negotiations on strategically significant contracts and management of third party service providers.
- Identify and recruit new providers to the medical network across both existing and new territories, thereby ensuring operational readiness for business expansion.
- In conjunction with the Underwriting Director, the Managing Director (Middle East and Africa) and the regional Business Development team, evaluate new and existing products and benefit structures to ensure their successful integration to provider contracts and the long-term Network management strategy.
- Promote our product, services and procedures to all network providers and TPAs so as to ensure a smooth customer experience for members and raise brand equity.
- Maintain consistently positive relationships with hospitals, clinics and TPAs, including circulation of product and service updates so that all network providers are aware of the full range of our benefits.
- Develop and maintain a full suite of provider training resources for the provider network, ensuring full awareness of our operational processes so as to support and continually improve our customer experience.
- Work with the Service Delivery Director, Head of Claims and Head of Clinical Services as required to resolve complaints related to claims, operations and payment with medical providers and TPAs.
- In conjunction with the Underwriting Director and Head of Claims, put in place rigorous fraud control measures and frameworks across the provider network.
- Conduct regular provider audits, highlighting risk findings and suggesting corrective actions for Underwriting, Claims and Operations. Close gaps and strengthen provider controls as required.
- Provide regular data analytics for monthly management reports and make recommendations towards managing the risk experience.
- Continuously research and report on evolving risk trends within the international private medical insurance industry and advise on appropriate benchmarking strategies.
- Establish and maintain up-to-date personal awareness of all legislative, regulatory and Company-specific rules, policies and procedures related to performance of the role.
- Ensure consistent compliance with legal, regulatory and Company standards in line with underwriter requirements.
- Pay particular attention to the Companys Information and Data Security policies when accessing and using all Company systems which may provide access to sensitive information assets, and strive to maintain the highest possible standards of information protection at all times.
- Take individual responsibility for accessing only the systems, records and information required to perform the role.
- Treat all data contained within those systems in a manner consistent with the Companys Information and Data Security policies, and in line with the confidentiality clauses provided within the employment contract.

Requirements

- Qualified to degree level in a related discipline.
- Comprehensive experience in delivering commercially viable and sustainable network relationships within the medical insurance industry. International experience is preferred. Candidates with an insurance or Third Party Administration background will be considered.
- A proven track record of controlling and reducing external spend whilst developing a robust provider base.
- Excellent verbal and written communication skills; business-level English is essential, additional local language abilities (especially Arabic) are advantageous.
- Understanding of financial processes and procedures and of managing budgets.
- First-rate analytical and written skills with the ability to research, structure and write a variety of documents (including those involving numerical or statistical analysis) with minimal supervision or correction.
- Substantial experience of successfully managing medical provider network services across a range of global locations with varying legislative and cultural requirements.
- A demonstrable track record of building and maintaining positive working relationships with managers, colleagues and external stakeholders from multiple cultural backgrounds.
- A high degree of IT literacy, including Microsoft Excel and Powerpoint.
TRAITS
- A tough negotiator with strong commercial acumen
- Positive attitude to taking on a broad range and variety of responsibilities and tasks at short notice to meet the requirements of a variety of stakeholders. Able to prioritise and respond flexibly to changing demands.
- Professional confidence - able to establish credibility with medical professionals and other external stakeholders at all levels
- Proactive and solutions-oriented.
- Detail conscious with high accuracy standards.
- Willing to travel internationally across the Companys global offices.

About the Company

Building businesses, changing lives

At Tandem, we’ve built a vast network of top-tier professionals across the globe. We empower businesses to thrive by delivering unmatched talent solutions. With our global reach, collaborative approach, and unwavering commitment to excellence, we drive transformative growth and shape exceptional teams.

Who we are.

We are a team of industry experts, driven by a passion for innovation and excellence. We are dedicated to providing unique talent solutions and nurturing collaborative partnerships that redefine success.

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