Responsibilities

Key Responsibilities

1. Strategic Relationship Management

Act as the primary point of contact for all payer and funder accounts.
Build and maintain strong, collaborative relationships with insurance companies, TPAs, and government payers.
Conduct regular review meetings with funders to resolve issues, share performance insights, and align on strategic initiatives.

2. Contracting & Negotiations

Lead contract negotiations with payers (fee-for-service, bundled payments, capitation, PMPY, value-based care, etc.).
Evaluate reimbursement models, propose risk-sharing arrangements, and ensure financial viability for the hospital.
Monitor contract performance and initiate renegotiations to optimize terms.

3. Claims & Reimbursement Oversight

Collaborate with the revenue cycle team to track claim submissions, denials, and payment trends.
Escalate unresolved disputes with payers to ensure timely resolution.
Closely work with Reconciliation team and support in case of delayed dues.

4. Compliance & Policy Alignment

Stay updated on payer policies, regulatory guidelines, and healthcare financing trends in the region.
Ensure hospital services are aligned with insurance coverage criteria to avoid compliance risks.
Educate internal stakeholders (clinical and billing teams) on payer-specific requirements.

5. Business Analytics & Reporting

Analyze payer performance, revenue contribution, and contract profitability.
Provide regular dashboards and insights to leadership on payer mix, utilization patterns, and financial outcomes.
Identify opportunities for growth (new product/service coverage, enhanced network inclusion, etc.).

6. Cross-functional Collaboration

Work with clinical teams to support implementation of value-based care initiatives and care pathway alignment.
Partner with marketing/business development for new payer partnerships.
Support finance and strategy teams in developing forecasts and budgets based on payer contracts.

Desired Candidate Profile

Qualifications

Qualifications & Experience

Bachelor’s degree in Healthcare Management, Business Administration, Finance, or related field.
6–10 years’ experience in healthcare provider–payer relations, revenue cycle, or contracting (hospital/insurance sector).
Strong knowledge of healthcare financing models (FFS, DRG, bundled payments, risk-based contracts, capitation).
Excellent negotiation, analytical, and communication skills.
Familiarity with UAE healthcare regulatory frameworks and payer ecosystems