Claims and Provider Relations Manager

JOB SUMMARY The Claims and Provider Relations Managers is under the guidance of and reports to the Vice President of Operations. The key job objective is to plan, co-ordinate and monitor the functions of the department in an efficient manner.

MAIN DUTIES & RESPONSIBILITIES:

1. Assessing health and group life insurance ensuring thorough adjudication and accurate payments.
2. Ensure that claims are processed as per the agreed SLAs.
3. Accurate and timely management and processing of pre-authorization requests.
4. Effectively monitor provider utilization.
5. Monitor and maintain a sustainable provider network.
6. Conduct routine and ad hoc audits as and when required.
7. Supervision and leadership of the Claims and Provider Relations Team.
8. Prepare reports and attend meetings as and when required.
9. Review and implementation of claims processing policies and SOPs.
10. Perform any other duties assigned.

QUALIFICATION & EXPERIENCE REQUIRED

• First Degree in Management Studies, Business Administration or related discipline.
• At least 5 years’ management experience in the health insurance industry in a similar capacity.
• Working knowledge of Health Insurance Operations.
• Industry knowledge is required.
• Training as a Registered Nurse would be an asset.

SPECIFIC KNOWLEDGE REQUIRED

• Adept in the use of Microsoft Office Suite (with emphasis on Microsoft Word & Excel)
• Health Insurance Associate (HIA) Designation
• Life Office Management Association (PARTS 1 and 11)

SPECIFIC SKILLS OR COMPETENCIES REQUIRED

• Excellent written and oral communication skills
• Excellent interpersonal skills
• Excellent administrative skills
• High level of professionalism and flexibility
• Must own and operate a reliable motor vehicle

We thank all all applicants for the applications of interestes, however, only candidates who meet our requirements and are shortlisted will be contacted.

Please submit your applications no later than Sunday, February 8, 2026.