15/05/2026
WE ARE HIRING!
Provider Relations Officer
Department: Provider Relations
Reports To: Head, Provider Relations
Main Responsibilities
Processing of Claims Requests
- Assess, evaluate, and process claims requests in accordance with the client’s policy contract terms and in line with internal policies and procedures.
Strategy & Planning
- Ensure appropriate interaction and engagement with service providers to enhance and enrich the client experience, leading to overall deep client satisfaction.
- Execute actions and strategies to improve and maintain strong relationships with service providers.
- Liaise with the Client Relations Unit to stay informed of service complaints from clients and leverage service provider relationships to promptly resolve challenges.
Financial & Performance Management
- Assist in conducting assessments, establishing accreditation, negotiating price tariffs, performing claim reconciliations, and obtaining approvals for service agreements with all service providers.
- Ensure prompt completion of claim processes by diligently evaluating all submissions.
- Perform duties in a manner that ensures fraudulent and fictitious claims are detected, declined, and reported accordingly.
- Ensure accurate capturing and processing of correct claims to avoid payment errors.
- Update or lock all approved or negotiated prices in the Pether Insure software.
Risk Management
- Exercise diligence in undertaking duties to reduce the risk of errors leading to possible losses (operational, etc.).
- Ensure operational activities comply with internal policies and procedures as well as regulatory requirements.
- Ensure timely completion of processes to enable the Client Relations team to deliver efficient services to clients.
Service Delivery
- Log and perform relevant initial claims administration processes on submitted claims.
- Ensure all discrepancies, errors, or deficiencies in submissions are resolved.
- Work with the Supervisor/Manager through the claim validation and approval process, and ensure claims are not delayed.
- Liaise with the Finance Unit/Department to ensure claims payments are processed, approved, and forwarded to clients or service providers within agreed timelines.
- Generate and collate reports, as well as perform data reconciliation assigned by the Supervisor/Manager (list of schedules, parameters, periods/timelines to be determined).
- Perform claims data reconciliation to confirm system integrity and highlight irregularities and inconsistencies in the system and data.
- Ensure the provider interface in the claims software is installed for designated service providers and that their staff are trained in its usage.
- Ensure tariff (update) guides are submitted by service providers promptly.
- Conduct regular mystery site visits to provider facilities.
- Visit service providers to discuss necessary status reports or information on relevant activities, and resolve provider concerns within 24 hours.
- Liaise with service providers to ensure services are not delayed due to benefit or service discrepancies or errors in the software system or contract.
- Collate relevant reports on provider status and feedback received from providers and claims, and submit them to Management.
- Investigate and reconcile suspicious and contentious claims both during and after client visitations.
- Liaise with the Client Relations Unit to resolve service challenges with providers.
- Ensure regular on-site reconciliation at provider facilities.
- Liaise with service providers and the internal medical team to pre-authorise specific services.
- Ensure pro-forma invoices are validated for specific services.
- Notify providers about new additions to the scheme monthly.
- Educate service providers on the benefits and exclusions of GLICO Health Insurance packages.
- Leverage relationships with service providers to generate referrals for the sales team.
- Update service providers on new developments in the claims software.
- Provide monthly updates on newly accredited facilities to the Claims, Sales, and Underwriting Units.
- Update the service provider list on a monthly basis.
- Assist the Supervisor/Manager in nationwide provider accreditation processes.
- Prepare service provider agreements.
- Discharge duties in a manner that does not bring GLICO Health Insurance Ltd. into disrepute, harm its image, or damage its brand value.
Communication & Working Relationships
Internal
- Client Relations Team
- Sales Team
- Underwriting Team
- Finance Team
- Audit Team
External
- Service Provider Management
- Service Providers’ medical, pharmaceutical and administrative staff
- Medical and Pharmaceutical Industry
Knowledge, Skills, Abilities & Competencies
- Appreciable relevant knowledge or experience in data entry and basic arithmetic/calculation methods.
- Strong dexterity and skill in spotting errors.
- Sound knowledge of internal processes, with sufficient knowledge of regulatory requirements to enhance the ability to deliver expected results.
- Strong interpersonal skills coupled with professional integrity in order to command respect and credibility with internal stakeholders and in situations involving conflicting interests.
- Good understanding of insurance services relevant to health insurance provision and regulatory requirements.
- Appreciable experience in the insurance industry or other financial industries is an advantage.
- Ability to withstand pressure, work fast, set priorities, organise, and manage time among situations needing urgent attention simultaneously, with initiative, creativity, resourcefulness, analytical ability, energy, and determination to successfully perform tasks.
- Up-to-date knowledge of general economic conditions, including financial and health sector knowledge relative to insurance.
- Ability to communicate well, both orally and in writing, and to conduct provider-related meetings (even in hostile/confrontational circumstances and/or at very senior corporate levels) while focusing on relevant issues.
- Ability and willingness to exercise initiative, make decisions, take responsibility, and accept accountability for actions taken and decisions made.
Key Strengths
- Relationship building, persuasiveness, creativity, assertiveness, focus-driven.
- Must possess drive to pursue goals/targets and maintain high standards of operation.
Education
- A good first degree with relevant certification in Insurance, Healthcare Administration, or a related field.
