Network and Wellness Coordinator

Job description

Network and Wellness Coordinator

Operations

 

 

Purpose of the Role

 

As a Network and Wellness Coordinator you will oversee agreements with and monitors performance of hospitals/clinics/doctors and other medical providers for the medical service needs of AZPNBL clients.  You will also identify possible medical providers for AZPNBL and initiates accreditation and negotiation of service costs.  

 

You will ensure that the Service Level Agreements between AZPNBL and partner hospitals/clinic/doctors are met and draws attention to the benefits of the member's benefit plan and aggressively urges members to avail their wellness benefit. Lastly, you will guarantee that the team is promptly informed about every issue in details and carry out any additional responsibilities appropriate to the role and required.

 

 

Responsibilities of the Role

 

·  Contracting with Philippine medical providers - must have agreements in place with medical providers based on agreed plan, ensuring that internal and external regulations are complied with, and service level requirements adequately reflected in the agreements. Measured by the number of agreements concluded and timeliness of implementation.
·  Maintenance of network - Ensures a smoothly functioning network and   good relations with provider network teams, to an extent that AZPNBL becomes an insurer-client of choice with the providers.  Measured by response time of provider networks and their achievement relative to agree upon service levels; also, the timeliness and appropriateness of the Network Specialist's intervening actions.
·  AZPNBL Client satisfaction - Regular monitoring of the effectiveness of existing network with the objective of achieving the ideal customer experience (relative to network).  Measured via the satisfaction level of the clients with respect to medical network services.
·  Assessment of usual and customary expenses - Review requests for pre-authorization and assess applicability of expenses to treatment and diagnosis.
·  Fraud Manager

 

 

Requirements for the Role

 

·  A graduate of Bachelor of Science in Nursing and or any four-year medical courses.
·  At least three (3) years of experience working in a hospital or any medical insurance industry.
·  Possesses strong analytical skills and pays close attention to details.
·  Has advanced knowledge of medical terms, procedures, and illnesses.
·  Maintains a high level of quality of communication both written and oral English and Filipino.
·  Competence reviewing medical records seeking facts required for investigation/quality review.
·  Ability to work collaboratively with managers, staff, and all accredited third-party administrator.
·  Strong negotiation skills and has excellent in information searching.

 

46158 | Customer Services & Claims | Professional | Allianz Philippines | Full-Time | Permanent
 

Allianz Group is one of the most trusted insurance and asset management companies in the world. Caring for our employees, their ambitions, dreams, and challenges, is what makes us a unique employer. Together we can build an environment where everyone feels empowered and has the confidence to explore, grow, and shape a better future for our customers and the world around us.

 

We at Allianz believe in a diverse and inclusive workforce and are proud to be an equal opportunity employer. We encourage you to bring your whole self to work, no matter where you are from, what you look like, who you love, or what you believe in.

 

We, therefore, welcome applications regardless of ethnicity or cultural background, age, gender, nationality, religion, disability, or sexual orientation.

 

Join us. Let's care for tomorrow.