The Provider Relations Officer – Health is responsible for developing, managing, and sustaining relationships with healthcare provider networks to secure high-quality and cost-effective healthcare services. The primary objective is to shape a comprehensive and integrated healthcare system by fostering a seamless and efficient service network.
Responsibilities
Strategic Partnerships: Engage continuously with providers to ensure the provision of high-quality, cost-effective care.
Provider Network Management: Maintain an updated provider panel, monitor the adequacy of providers in all key regions, and conduct provider audits. Ensure provider contacts and lists are current and accurate.
Provider Relationship Management: Develop and maintain strong relationships to enhance provider and customer experience while ensuring adherence to contract terms. Organize service meetings and training on GA processes.
Provider Contracting: Assist in the contracting of providers and manage the provider contract lifecycle. Ensure all providers have signed contracts and submitted relevant KYC documentation.
Customer Service Support: Support the business development and underwriting teams by attending client service meetings to ensure a superior customer experience.
Compliance: Participate in updating provider KYC and licenses to ensure compliance with regulatory or health sector changes, such as health legislation affecting the business.
Cost Containment: Negotiate costs, analyze provider claims, and provide prompt data reports to inform decision-making in scheme cost controls.
Audits: Assist in carrying out country-wide provider audits to guarantee that quality, cost-effective medical services are maintained.
Internal Support: Provide guidance to the claims team and contact center agents on provider-related issues.
Requirements
Academic and Professional Qualifications
Diploma or Bachelor's degree in Nursing or Clinical Medicine is preferred.
Any insurance certification will be an added advantage.
Experience
At least 5 years of experience in clinical management or a similar role.
Prior relevant experience in health insurance is preferred.
Extensive knowledge of public and private healthcare providers in Kenya.
Technical Competencies
Proficiency in MS Office Package.
Experience in managing health insurance medical scheme services.
Knowledge of insurance industry concepts and regulatory requirements.
Demonstrated experience in provider onboarding requirements.
Working knowledge of diagnostic procedures within the Kenyan healthcare system.
Experience in claims management within medical scheme/health insurance provision.
Knowledge of emerging trends and procedures in health insurance management.
Experience in managing stakeholders in the health insurance ecosystem.
Behavioural Competencies
Strong strategic focus and vision.
Strong problem-solving, conflict management, and decision-making capability.
Ability to build strategic relationships and network.
High emotional intelligence and diplomatic sensitivity.
Innovative with the ability to challenge the status quo.
How to Apply
If you meet the above requirements and wish to be part of our vibrant team in the Health Department, please send your application letter and updated CV to careers@gakenya.com by 31st March 2026. Interviews will be held on a rolling basis. Please indicate the position you are applying for in the email subject line. Only shortlisted candidates will be contacted.
How to Apply
If you meet the above requirements and wish to be part of the vibrant Provider support management team, Health Department please send your application letter and updated CV to the email address careers@gakenya.com by 31st March 2026. Interviews will be on a rolling basis. Indicate the position you are applying for on the email subject line. Only shortlisted candidates will be contacted.
