Medical Process Manager

• Communication, negotiation, and influence skills.
• Transversality and ability to work in a team.
• Flexibility to adapt to changing environments and a desire to acquire new skills and knowledge.

• Experience in insurance customer service/management will be valued
• Experience in data entry will be valued

• Vocational Training in Administration and/or Business Administration (ADE)

The mission of this position will be to update and maintain the Medical Management database (healthcare providers, medical nomenclator, provider rates, assignment of procedures to product modalities...etc.) as well as related systems (Chip Card / electronic invoicing) and the Health provider document manager (Filenet) with requests for incorporation into the medical network following the established process.

• Management of the economic agreements agreed upon by the Expense Control team with our Healthcare Providers, ensuring they are recorded correctly in the system, thereby avoiding the payment of benefits with incorrect amounts and thus reducing payment incidents to providers that both CISS and the Benefits Department may receive. Guaranteeing the update of the rates negotiated with each medical Provider in the application.
• Register, administratively assess, and manage requests for the incorporation and expansion of medical specialties of Healthcare Providers in collaboration with the Health Planning and Expense Control team, always prioritizing and accelerating the procedures deriving from the Distribution Area, thus contributing to the growth and/or retention of our insured portfolio.
• Updating and maintaining in all Medical Management systems (SAP, Filenet, ChipCard, Medic Expert) the Medical Network of health providers (and all related documentation), guaranteeing that the information is current and completely up to date, thus avoiding incidents with our insured members and the possible payment of expense reimbursement invoices derived from these incidents. Additionally, this management contributes to generating trust in our distributors, potentially impacting the retention and/or increase of our insured portfolio.