Senior Executive Provider Network Management

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

Senior Executive Provider Network Management

About the role The Senior Executive, Provider Network Management will independently manage assigned healthcare providers and support the performance, governance and continuous improvement of ProtectHealth's provider network.

The role covers the provider lifecycle, performance monitoring, provider engagement and operational issue resolution, while supporting cost containment, care outcomes and Fraud, Waste & Abuse (FWA) initiatives through data analysis and cross-functional collaboration.

Key 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.

Analyse provider performance, utilisation and operational data to identify trends, gaps and areas for improvement.

Coordinate provider performance reviews and follow up on corrective and improvement actions.

Manage provider enquiries, operational issues and escalations within the assigned portfolio.

Support healthcare cost-containment and FWA monitoring initiatives.

Support provider contract administration, renewals, amendments and compliance monitoring.

Prepare provider performance reports, analyses and recommendations for management.

Support provider audits, compliance reviews and governance activities.

Participate in process improvement, automation and digitalisation initiatives.

Work closely with internal stakeholders, healthcare providers and relevant partners to support effective service delivery.

What we're looking for

Bachelor's Degree in Healthcare Management, Medicine, Pharmacy, Nursing, Allied Health, Business Administration, Health Administration or a related discipline.

Approximately 4-7 years of relevant working experience within healthcare, hospitals, health insurance, managed care, TPA or provider network environments.

Relevant experience in provider/panel management, provider relations or healthcare operations.

Experience in provider empanelment, credentialing, performance monitoring or contract administration would be highly advantageous.

Exposure to healthcare cost containment and/or Fraud, Waste & Abuse (FWA) would be an advantage.

Experience working with provider performance, utilisation or healthcare operational data.

Strong analytical, problem-solving, stakeholder management and communication skills.

Exposure to patient/care outcome management or analysis would be an added advantage.

Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly-owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).

As a not-for-profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.

Incorporated on 19 December 2016, ProtectHealth Corporation Sdn Bhd (ProtectHealth) is a wholly-owned subsidiary of ProtectHealth Malaysia, established under the Ministry of Health, Malaysia (MOH).

As a not-for-profit company, ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services as mandated by MOH.

Researching careers? Find all the information and tips you need on career advice.