Provider Relations Specialist
- Ontario
- Permanent
- Full-time
Toronto, Ontario
Reference # AC- 6225Meridia Recruitment Solutions has partnered with BF&M Group of Companies, a multinational insurance organization on their search for a Provider Relations Specialist
to join their team. The Provider Relations Specialist will support our client's organization efforts to ensure access to high-quality, cost-effective healthcare services through effective contracting, problem resolution, and provider engagement. This role will be situated in Toronto and report to the Head of Benefits Insurance & Provider Relations.Your Responsibilities:
- Establish and maintain strong relationships with hospitals, healthcare networks, air ambulance companies, pharmacies, and medical professionals in key jurisdictions including but not limited to Bermuda, the Cayman Islands, the UK, Canada, and the US
- Act as the main liaison between the organization and international medical offices, supporting relationship-level issue resolution
- Maintain provider contracts, compliance, and ongoing performance monitoring i.e. SLAs
- Manage provider escalations related to policy coverage
- Coordinate with internal and external stakeholders to support on-going provider education and communication in relation to plan benefits and policies
- Contribute to the development and refinement of workflows and policies related to provider and client contracts
- Analyze provider utilization and billing trends to identify cost-saving and service improvement opportunities
- Work alongside the case management and business solutions teams regarding pricing, contracting and escalations
- Respond to RFPs/RFIs
- Participate in presentations, meetings, and initiatives involving providers or clients as needed
- Travel internationally to support provider relationship management and attend key meetings
- Perform other related duties as required
- Diploma or Degree in health sciences, business or healthcare administration, or related field
- Five - ten years' work experience in the healthcare provider relations, assistance services, or a related medical provider industry
- Experience with or knowledge of network development, contracting, compliance, managing multiple vendors and/or management of provider networks
- Experience with healthcare contract negotiation and/or claims cost containment is an asset
- Knowledge of international healthcare systems (Bermuda, US, UK, Canada, Cayman Islands) preferred
- Knowledge of health insurance policies and procedures preferred
- Computer literate with proficiency in desktop applications, especially Microsoft Office Suite
- Strong communication, negotiation, presentation and reporting skills
- Manage multiple assignments simultaneously and the ability to prioritize within assigned deadlines
- Be an analytical thinker, self-motivator, problem solver and capable of working independently