Expert, Health netwok Claims (Techcom Insurance)

Job Purpose

This role is directly responsible for developing, nurturing, and expanding deep strategic partnerships with medical service providers (public/private hospitals and high-quality clinics), particularly across top-tier cities including Ho Chi Minh City, Hanoi, Hai Phong, Hue, and Da Nang.

This role closely supports the Claims Director in expanding the direct billing network, delivering professional claims and Hospital Portal training to healthcare providers, conducting rigorous provider quality assurance (QA) checks, and acting as a Subject Matter Expert (SME) in designing and optimizing provider systems and portals. The position operates as an Individual Contributor (with potential to mentor/lead 1-2 junior members in the future), ensuring superior customer experience and prudent medical cost control. 

Key Accountabilities (1)

1. Strategic Provider Relationship Management, Network Expansion & Negotiation 
- Deep Relationship Building: Cultivate and maintain deep, high-trust strategic relationships with medical service providers across Ho Chi Minh City, Hanoi, Hai Phong, Hue, Da Nang, and other provinces.
- Commercial Negotiation & Contracting: Support the Claims Director in leading commercial negotiations for direct billing agreements, preferential discount tariffs, flexible payment terms, and superior Service Level Agreements (SLAs) to maximize cost containment and policyholder advantages.
- Direct Network Governance: Coordinate and oversee the operational delivery of direct billing network; periodically evaluate network performance, geographical coverage, and accessibility to optimize the healthcare provider portfolio.
- Team Mentorship & Growth: Operate as a high-performing Individual Contributor, with the agility and readiness to coach, mentor, or lead 1-2 junior staffs in the future as the healthcare network expands.
        
        

Key Accountabilities (2)

2. Provider Claims Training, Hospital Portal Enablement & System SME Contribution 
- Claims & Billing Training: Design training materials and directly conduct comprehensive training programs for medical service providers' staffs on direct billing guidelines, claims procedures, and claims documentation standards.
- Hospital Portal Enablement: Train, onboard, and drive healthcare providers to actively and proficiently utilize this Hospital Portal for instant eligibility verification, electronic GOP submissions, real-time medical expense tracking, and fast billing reconciliation.
- System SME Contribution: Serve as the primary Subject Matter Expert (SME) collaborating with IT, Digital Transformation, and vendor teams to design, test (UAT), and optimize the direct billing core system, Hospital Portal, and direct data integration (API) with medical service provider systems.
        

Key Accountabilities (3)

Key Relationships - Direct Manager

Claims Director    

Key Relationships - Direct Reports

Manages a small team of 1-2 members    

Key Relationships - Internal Stakeholders

Internal function Division in company    

Key Relationships - External Stakeholders

Hospitals & Clinics, Regulators, etc.    

Success Profile - Qualification and Experiences

- Education: Bachelor's degree or higher in Public Health, Pharmacy, Healthcare Administration, Insurance, Business Administration, Economics, or related fields.
- Professional Experience: Minimum 3 years of direct experience in healthcare provider network management, direct billing operations, or hospital commercial relations at leading life/non-life insurance companies, TPAs, or reputable private hospital groups.
- Deep Healthcare Provider Relationships: Possess deep, trusted, and active relationships with leadership, general planning departments, and billing teams across top-tier hospitals and clinics, especially in Ho Chi Minh City, Hanoi, Hai Phong, Hue, and Da Nang.
- System SME & Portal Knowledge: Demonstrated experience contributing as an SME in developing or implementing healthcare direct billing systems, Hospital Portals, or digital health solutions.
- Language Proficiency: English Intermediate: Able to listen, read, and write in English for business correspondence, contracts, etc.).