Executive Provider Network Lead

PROTECTHEALTH CORPORATION SDN. BHD.; Cyberjaya; On-site; MYR 60,000 - 90,000; Full time

Job summary

ProtectHealth Corporation Sdn Bhd invites applications for a Senior Executive, Provider Network Management. The role independently manages assigned healthcare providers, overseeing performance, governance and continuous improvement within ProtectHealth's network.

Responsibilities include provider lifecycle management, engagement, data analysis for cost containment and FWA initiatives, and cross-functional collaboration to ensure quality service delivery.

Qualifications

• Bachelor’s degree in healthcare, medicine, pharmacy, nursing, allied health, business administration or related discipline.
• Approximately 4–7 years of relevant healthcare, hospital, health insurance or provider network experience.
• Experience in provider empanelment, credentialing, performance monitoring or contract administration is advantageous.
• Exposure to healthcare cost containment and/or Fraud, Waste & Abuse (FWA) is a plus.
• Strong analytical, problem-solving and stakeholder communication skills.

Responsibilities

• Manage provider empanelment, credentialing, onboarding, renewal, suspension and termination activities.
• Manage an assigned portfolio of healthcare providers and maintain effective provider relationships.
• Monitor provider performance against KPIs, SLAs, contractual requirements and service standards.
• Analyze provider performance, utilization and operational data to identify trends and gaps.
• Coordinate provider performance reviews and follow up on corrective/improvement actions.
• Manage provider inquiries, escalations and operational issues.
• Support cost-containment and FWA monitoring initiatives.
• Assist with provider contract administration and renewals.
• Prepare provider performance reports and recommendations for management.
• Support audits, governance activities and process improvement initiatives.
• Collaborate with internal stakeholders and partners to ensure effective service delivery.

Skills

Provider network management

Provider relations

Data analysis

Analytical thinking

Stakeholder management

Communication skills

Education

Bachelor's Degree in Healthcare Management or related field

Job description

ProtectHealth Corporation Sdn Bhd invites applications for a Senior Executive, Provider Network Management. The role independently manages assigned healthcare providers, overseeing performance, governance and continuous improvement within ProtectHealth's network.

Responsibilities include provider lifecycle management, engagement, data analysis for cost containment and FWA initiatives, and cross-functional collaboration to ensure quality service delivery.