Provider Relations Officer – Microinsurance

CIC Insurance Group Plc is an insurance company founded in 1968 and based in Nairobi, Kenya, offering various financial services.

Reporting to the Assistant Manager of Provider & Forensic Management, the Provider Relations Officer will be responsible for establishing and maintaining relationships with medical service providers. Key duties include negotiating terms, training providers on CIC's health products and processes, conducting audits to ensure adherence to company rules, and resolving issues identified by sales, underwriting, care, and claims teams. The officer will also manage the provider network, address complaints, and analyze utilization data to help contain medical costs.

1. Negotiate fees and terms with new service providers across all aspects, including consultation, procedures, and inpatient costs.
2. Provide training to service providers on new health products, process changes, new schemes, and underwriting rules to enhance client service.
3. Conduct unannounced audits of medical service providers to ensure compliance with CIC rules and procedures regarding member access and policy exclusions.
4. Collaborate with Sales, Underwriting, Care, and Claims teams to resolve service provider issues identified during scheme inception.
5. Facilitate the contracting, suspension, and termination of providers based on their adherence to working terms and conditions.
6. Negotiate for discounts with service providers and ensure these discounts are realized by coordinating with the medical claims and finance teams.
7. Maintain proper and up-to-date documentation for all service provider contracts.
8. Manage the provider network and onboard new providers to meet client needs for service access.
9. Address complaints related to service delivery, customer feedback, and payment matters with medical service providers.
10. Analyze medical service provider utilization data to develop strategies for managing and containing escalating medical costs.

1. Hold a Diploma in Nursing.
2. Possess a minimum of 3 years of relevant experience.
3. A Diploma in Insurance is considered desirable.