Senior Executive Manager PR Management📣 Job Ad

About the Role

Bupa Arabia is seeking a Senior Executive Manager - PR Contract Management to join our team in Jeddah. This full-time role is central to achieving effective contract management and network design for healthcare providers, ensuring compliance with CCHI & SAMA rules and regulations. The position focuses on delivering effective price and cost management, driving project savings, and aligning with sales and marketing to develop new products and services that support business growth and profitability in the insurance market.

Core Responsibilities

• Implement and manage provider contracts and network design strategies in adherence to CCHI & SAMA regulations.
• Drive effective price and cost management initiatives to achieve significant project savings.
• Collaborate with sales and marketing teams to continuously develop new products and services that enhance business development and market proposition.
• Contribute to achieving overall business profitability and expansion goals within the insurance sector.

Contract and Network Strategy

• Establish and enforce contract rules and standards with all providers to serve business interests.
• Oversee the contracting of new providers, new service codes, and contract renewals, ensuring regulatory compliance.
• Develop and implement comprehensive benchmarking systems for frequently billed items, both regionally and per network.
• Create processes and guidelines for pricing non-benchmarked items fairly and reasonably.
• Design and optimize the provider network to ensure comprehensive coverage across all benefits and classes, enhancing accessibility and affordability.
• Manage pharmacy benefits, including networking, formularies, and refill systems.

Pricing, Cost Management, and Innovation

• Revamp the coding system, introducing unified parent codes and eliminating redundancy, while implementing ICD 10-am systems.
• Resolve issues related to invalid/duplicate service codes and overbilling.
• Develop standard discount structures, PPD rules, and volume discount slabs.
• Formulate and negotiate price reduction plans and service bundling agreements (in-patient and out-patient) to meet business objectives.
• Manage volume re-allocation among providers and enhance stepladder referral systems for cost-effectiveness.
• Explore and develop new payment approaches (*, prepaid services, accountable care organizations) and strategic provider partnerships.
• Introduce new healthcare plans, products, and services responsive to market needs and business developments.

Team Leadership and Stakeholder Coordination

• Provide leadership, professional guidance, and direction to the assigned team members.
• Prepare, oversee, and review Key Performance Indicators (KPIs) for the team, facilitating goal setting and performance management.
• Offer regular feedback, coaching, and development opportunities to direct reports, empowering them with necessary tools and support.
• Ensure clear communication of contract additions/deletions, amendments, and milestones to operation teams and technical stakeholders.
• Communicate regular price forecasts to commercial finance and coordinate network redesigns and referral system updates with operations and sales.

Experience and Qualifications

The ideal candidate will possess 5-10 years of relevant experience in contract management, network design, or a similar strategic role within the insurance or healthcare sector. A strong understanding of CCHI & SAMA regulations, along with proven negotiation and leadership skills, is essential for success in this position.