Head of Network Pricing and Analytics
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Key skills for this role
About the Role
Sukoon Insurance seeks a Head of Network Pricing and Analytics to lead provider network strategy, cost management, and analytics. The role requires a Bachelor's degree, 5+ years in healthcare network management in UAE, and strong negotiation skills.
Key Skills for This Role
Responsibilities
- Define and execute the provider network strategy (hospitals, clinics, diagnostics, pharmacies)
- Ensure optimal geographic coverage and specialty mix in line with regulatory mandates and BUPA/Client priorities
- Identify and onboard high quality providers aligned with pricing targets
- Lead tariff negotiations and contracting with providers
- Drive cost containment initiatives (packages, bundled pricing, caps)
- Balance cost vs. quality vs. accessibility
- Maintain strong relationships with key providers
- Act as escalation point for operational and commercial issues
- Lead strategic partnerships and long term agreements
- Ensure providers meet clinical quality and accreditation standards
- Collaborate with medical teams on outcomes, protocols, and audits
- Monitor adverse events, complaints, and clinical risks
Requirements
- Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field
- Master’s degree (MBA, MHA, or equivalent) is preferred
- Minimum 5 years of experience in healthcare network management, provider relations, insurance/TPA, or healthcare operations in UAE
- Proven experience managing provider networks, contracts, and cost optimization initiatives
- Strong background in health insurance, medical claims, or healthcare financing
- Solid understanding of medical cost drivers, claims management, and reimbursement models
- Experience with provider contracting, negotiations, and SLA management
- Familiarity with network adequacy standards, access to care metrics, and healthcare regulations
- Ability to analyze and interpret financial, operational, and healthcare performance data
- Experience with cost containment strategies and bundled/package pricing models
- Strong analytical skills with ability to track KPIs, identify trends, and drive data based decisions
- Proficiency in Excel and reporting tools (Power BI, Tableau, or similar is an advantage)
Full Job Posting
Job Purpose
- To develop, manage, and optimize the provider network to ensure cost effective, high quality, and accessible healthcare services aligned with business objectives, customer satisfaction, and regulatory requirements.
Key Accountabilities
- Network Strategy & Development: Define and execute the provider network strategy (hospitals, clinics, diagnostics, pharmacies). Ensure optimal geographic coverage and specialty mix in line with regulatory mandates and BUPA / Client priorities. Identify and onboard high quality providers aligned with
- Cost Management & Commercial Negotiation: Lead tariff negotiations and contracting with providers. Drive cost containment initiatives (packages, bundled pricing, caps). Balance cost vs. quality vs. accessibility.
- Provider Relationship Management: Maintain strong relationships with key providers (e.g., Mediclinic, American, Burjeel, Aster, including but not limited to top 30 groups). Act as escalation point for operational and commercial issues. Lead strategic partnerships and long term agreements.
- Quality & Clinical Governance: Ensure providers meet clinical quality and accreditation standards. Collaborate with medical teams on outcomes, protocols, and audits. Monitor adverse events, complaints, and clinical risks.
- Operational Performance: Oversee network operations (onboarding, credentialing, renewals). Ensure smooth claims interactions between providers and insurer. Resolve bottlenecks impacting customer experience.
- Stakeholder Management: Work closely with Claims, Underwriting, Sales, and Customer Experience teams. Support product development with network insights. Engage regulators and align with DHA/DOH guidelines.
- Data & Analytics Driven Decisions: Leverage utilization, claims, and cost data to optimize the network. Identify leakage, abuse, or inefficiencies. Drive continuous improvement initiatives.
Key Performance Indicators
- Financial & Cost Management: Medical Cost Trend (%) vs Target, Network Savings / Discount Achievement, Average Cost per Claim / per Member, Cost Leakage Reduction.
- Network Effectiveness: Coverage Across Key Specialties & Geographies (%), Member Access Coverage (%), Network Adequacy Score.
- Provider Performance: Provider Quality Scores, Turnaround Time (TAT), Provider SLA Adherence.
- Customer Experience: Provider Related Complaints, Net Promoter Score (NPS) / Satisfaction, Access to Care Metrics.
- Operational Efficiency: Contract Renewal Cycle Time, Provider Onboarding Turnaround Time, Claims Rejection & Dispute Rates.
- Strategic Impact: Utilization of Preferred / Strategic Providers (%), Adoption of Bundled Pricing / Packages, Cost Containment Initiatives.
Qualifications & Requirements
- Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field
- Master’s degree (MBA, MHA, or equivalent) is preferred
- Minimum 5 years of experience in healthcare network management, provider relations, insurance/TPA, or healthcare operations in UAE.
- Proven experience managing provider networks, contracts, and cost optimization initiatives
- Strong background in health insurance, medical claims, or healthcare financing
- Solid understanding of medical cost drivers, claims management, and reimbursement models
- Experience with provider contracting, negotiations, and SLA management
- Familiarity with network adequacy standards, access to care metrics, and healthcare regulations
- Ability to analyze and interpret financial, operational, and healthcare performance data
- Experience with cost containment strategies and bundled/package pricing models
- Strong analytical skills with the ability to track KPIs, identify trends, and drive data based decisions
- Proficiency in Excel and reporting tools (Power BI, Tableau, or similar is an advantage)
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