Healthcare Provider Network Officer
QLM Life & Medical Insurance Company Q.P.S.C. is a leading Qatari insurer specializing in life and medical insurance solutions, primarily serving corporate clients, government entities, and individuals with health and employee benefits coverage.
The Medical Network Officer is responsible for managing and developing the relationship between the insurance company and its network of healthcare providers (hospitals, clinics, pharmacies, and diagnostic centers).
The primary objective of this role is to ensure network expansion, guarantee the quality of medical services provided to policyholders, and control healthcare costs through effective negotiation.
Network Recruitment and Expansion: Identifying and contracting with new medical service providers to expand the company’s geographical and service coverage.
Tariff Negotiation: Negotiating prices for medical services, discounts, and updating tariff schedules to ensure cost containment.
Contract & SLA Management: Drafting and reviewing Service Level Agreements (SLAs) and legal contracts with hospitals and clinics and following up on their renewal.
Problem and complaint resolution: Acting as the primary point of contact for resolving disputes related to overdue financial claims, or interpreting contract terms between the company and hospitals.
Onboarding & Training: Training hospital insurance staff and supervisors on company policies, electronic medical approval systems, and coverage rules.
Audit and Quality Assurance: Conducting field visits and periodic audits of medical centers to ensure their compliance with medical quality standards and agreed policies.
Qualifications and Requirements
Academic qualification: Bachelor’s degree in a medical or health specialty (and holders of nursing, pharmacy, human medicine, or healthcare management certificates are highly preferred ).Experience: 2 to 5 years of practical experience in the health insurance sector, provider relationship management, or working as an insurance coordinator within a large hospital in Qatar.
Personal skills: Exceptional negotiation and persuasion skills, and strong communication skills to build long-term professional relationships.
Technical knowledge: A deep understanding of medical terminology, billing procedures, medical coding systems (such as ICD-10), and medical prior approval mechanisms.
Languages: Proficiency in both Arabic and English, spoken and written, to deal with different nationalities in the Qatari medical sector.
الراتب المدفوع: QAR٧٬٠٠٠٫٠٠ لكل شهر
موقع العمل: بشكل شخصي
