TRICARE - Head of Network Administration

Aspire Insurance Advisers ,
London, Greater London
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Company Description International SOS is in the business of protecting and saving lives, when involved in medical or security situations. With more than 11,000 multi-cultural medical, security and logistics full-time experts stand by to provide support and assistance from over 1,000 locations in 90 countries, in more than 95 languages, giving you and your workforce peace of mind 24/7, every day of the year, be it online, on call or on-site. TRICARE delivers managed healthcare and medical services to the US military and their families overseas. With upwards of 320,000 beneficiaries across the Globe, TRICARE is entering an exciting phase as it prepares for the delivery of a new operational model and a clinically led and quality focused network of providers. Job Description We are currently recruiting a TRICARE Head of Network Administration to join our team in Chiswick, West London. The main focus of this role is to ensure the effective and efficient administration of the TRICARE Network including all credentialing and accreditation activities and the maintenance of accurate data standards in the SPIN system. The successful candidate will also corroborate the education and training of providers for TRICARE claims, promote the use of electronic submission and payment methods and ensure that claims issues are resolved promptly and accurately. In this role, they will be working closely with our claims processor, WPS, who are based out of Madison, WI. They will also lead TRICARE's pricing efforts with providers, leveraging global, regional and In Country resources to negotiate and reflect accurately discounts obtained. The Head of Network Services will also play a key role in projects related to Network and SPIN upgrades, leading TRICARE's contribution and working closely with TRICARE and Intl SOS stakeholders to ensure efficient and effective outcomes for development projects. Key Responsibilities: * Establishes, maintains and monitors data standards for TRICARE's core accreditation, credentialing and clinical quality database * Ensures provider accreditation and credentialing are kept up to date, working with Clinical Quality and Relationship teams * Works with Regional Service Delivery and In Country Teams to ensure only accredited, credentialed and quality approved providers used * Lead TPSS, In Country Claims teams and WPS Oversight Manager to ensure TRICARE claims processes understood by providers and responsible for resolution of claims issues * Works with In Country, Regional Relationship and WPS teams to promote efficient and effective claims submission and payment methods, including existing and new digital solutions * Leverages Intl.SOS and TRICARE Network teams to set standards for pricing negotiations and their effective monitoring and reporting by WPS & TRICARE management Qualifications Required skills and experience * Strong relevant experience required, preferably claims experience; hospital administration and TRICARE background/knowledge * Excellent managerial and supervisory skills * Excellent English, verbal and written communication skills; additional language preferred * Understanding of medical terminology, healthcare administration and preferably claims processing * Data management and business process design, combined attention to detail around data collection and input * Excellent interpersonal skills and ability to build relationships with a variety of service providers including medical and legal professionals * Understanding of healthcare pricing in key major markets * Solutions oriented set in the context of a highly regulated and compliance driven environment * Proficient in Microsoft Office Suite or similar software Additional Information Travel / Rotation Requirements * Up to 25% of time Closing date for applications: Friday the 15th of May 2020 Diversity & Collaboration Our company brings together remarkable people and enables them to be themselves. At International SOS, we offer a great working environment, thanks to our commitment to flexible working environment, diversity and development. We celebrate diversity on a global scale. We encourage every colleague to bring their personal best by creating an environment of inclusion and equal support. Our success is the result of diverse ideas, skills and cross cultural understanding. www.internationalsos.com International SOS has been recognised as a Top Employer in the UK by the Top Employer's Institute (TEI) for 2020 Qualifications: Required skills and experience Strong relevant experience required, preferably claims experience; hospital administration and TRICARE background/knowledge Excellent managerial and supervisory skills Excellent English, verbal and written communication skills; additional language preferred Understanding of medical terminology, healthcare administration and preferably claims processing Data management and business process design, combined attention to detail around data collection and input Excellent inter

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