Provider Management Officer

PROVIDER MANAGEMENT OFFICER
Job Title: Provider Management Officer
Department: Health Services
Reports To: Head of Health Services
Location: Abuja, Nigeria
Employment Type: Full-Time
Experience: 0–2 Years
1. JOB PURPOSE
The Provider Management Officer is responsible for supporting the effective management and coordination of relationships between the HMO and its network of healthcare providers. The role involves provider communication, documentation, monitoring of provider performance, handling provider enquiries, supporting onboarding and credentialing processes, and ensuring that providers comply with agreed service standards and contractual requirements.
The successful candidate should be organized, proactive, analytical, professional, and able to maintain effective working relationships with healthcare providers and internal stakeholders.
2. KEY RESPONSIBILITIES
Provider Relationship Management
• Maintain effective and professional relationships with hospitals, clinics, pharmacies, laboratories, and other healthcare providers within the company's network.
• Serve as a point of contact for routine provider enquiries and communications.
• Communicate relevant company policies, procedures, service updates, and operational information to providers.
• Follow up with providers on outstanding requests, issues, documentation, and other operational matters.
• Support regular communication and engagement with providers to promote effective service delivery.
Provider Onboarding and Documentation
• Support the onboarding of new healthcare providers in accordance with approved company procedures.
• Collect and review required provider documentation and ensure that records are complete and properly maintained.
• Assist with provider credentialing, registration, verification, and documentation processes.
• Maintain an updated database of active, suspended, and inactive healthcare providers.
• Support the renewal and updating of provider agreements and relevant documentation.
Provider Performance Monitoring
• Monitor provider compliance with agreed service standards, contractual obligations, and company requirements.
• Track provider-related complaints, service issues, and recurring operational challenges.
• Assist in preparing provider performance reports for management review.
• Identify recurring provider issues and escalate them to the appropriate supervisor.
• Support provider audits, assessments, visits, and quality monitoring exercises when required.
Provider Complaints and Issue Resolution
• Receive and document complaints and enquiries from healthcare providers.
• Coordinate with relevant departments to resolve provider-related issues promptly.
• Follow up on outstanding provider concerns until resolution.
• Escalate complex or unresolved issues to the Head of Provider Management or relevant management officer.
• Maintain accurate records of provider complaints and resolutions.
Claims and Operational Coordination
• Liaise with the Claims, Health Services, Accounts, Underwriting, and other relevant departments on provider-related matters.
• Support the resolution of provider concerns relating to claims, approvals, payments, authorisations, and service delivery.
• Follow up on outstanding provider documentation required for claims or other operational processes.
• Assist in identifying discrepancies or recurring issues affecting provider operations and escalate appropriately.
Provider Visits and Engagement
• Participate in provider visits, meetings, monitoring exercises, and engagement activities as assigned.
• Prepare relevant documentation and reports following provider visits.
• Document findings, observations, and agreed action points from provider engagements.
• Follow up on corrective actions arising from provider assessments or meetings.
Reporting and Administration
• Maintain accurate and up-to-date provider records and correspondence.
• Prepare daily, weekly, or monthly provider management reports as required.
• Maintain proper filing of provider contracts, licences, accreditation documents, correspondence, and other relevant records.
• Update provider information on approved systems and databases.
• Ensure provider-related information is handled confidentially.
• Perform other administrative and operational duties assigned by the supervisor.
3. KEY PERFORMANCE INDICATORS (KPIs)
Performance will be assessed based on:
• Timeliness of provider enquiries and complaints resolution.
• Accuracy and completeness of provider records.
• Timely onboarding and documentation of new providers.
• Provider compliance with agreed standards and contractual requirements.
• Follow-up and closure rate of outstanding provider issues.
• Timeliness and accuracy of provider reports.
• Quality of provider communication and relationship management.
• Timely escalation of unresolved provider issues.
• Completion of assigned provider visits and monitoring activities.
• Compliance with company policies and provider management procedures.
4. QUALIFICATIONS AND EXPERIENCE
• Bachelor's degree or HND in Health Administration, Business Administration, Public Administration, Insurance, Health Management, or a related field.
• 0–2 years' relevant work experience in provider management, healthcare administration, customer relations, insurance, HMO operations, or a related field.
• Candidates with internship, NYSC, or relevant healthcare administrative experience may be considered.
• Previous experience working with healthcare providers or an HMO is an added advantage.
5. REQUIRED SKILLS AND COMPETENCIES
• Good verbal and written communication skills.
• Strong interpersonal and relationship-management skills.
• Good administrative and organisational abilities.
• Excellent follow-up and coordination skills.
• Problem-solving and conflict-resolution abilities.
• Attention to detail and accuracy.
• Basic analytical and reporting skills.
• Good knowledge of Microsoft Office applications.
• Ability to maintain accurate records and manage documentation.
• Ability to work with healthcare providers and internal teams professionally.
• Ability to work under pressure and meet deadlines.
• Willingness to learn and adapt to new systems and processes.
6. PERSONAL ATTRIBUTES
The ideal candidate should be:
• Professional and courteous.
• Proactive and responsible.
• Organised and detail-oriented.
• Patient and diplomatic when handling provider concerns.
• Reliable and committed to meeting deadlines.
• Solution-oriented and willing to take initiative.
• Honest and trustworthy.
• A good team player.
• Able to communicate effectively with people at different levels.
• Willing to learn and develop professionally.
7. WORKING RELATIONSHIPS
The Provider Management Officer will work closely with:
• Management
• Health Services
• Underwriting
• Claims
• Accounts/Finance
• Customer Relations
• HR & Administration
• IT
• Healthcare Providers
• Corporate Clients and other relevant stakeholders
8. AUTHORITY AND RESPONSIBILITY
The Provider Management Officer is responsible for handling routine provider management activities within approved policies, procedures, and service standards. Matters involving contractual decisions, financial commitments, provider suspension or termination, major disputes, or other management-level decisions must be escalated to the appropriate supervisor or management.
9. CONFIDENTIALITY
The officer shall maintain strict confidentiality regarding provider information, contracts, healthcare-related information, company records, and other sensitive information obtained in the course of employment. All information must be handled in accordance with company policies and applicable regulatory and data protection requirements.
10. GENERAL DUTIES
The Provider Management Officer shall perform any other reasonable duties related to provider management, healthcare operations, and business activities as may be assigned by the supervisor or management from time to time.