Provider Database and Service Specialist
Santo Domingo, Dominican Republic
hace 4 días

Job Introduction

Manage in a comprehensive way directly or with other teams’ support, the process of capturing, storing, and analysing the information related to medical providers and their claim spend for BGLA seeking an optimal level of data quality and efficient use of the information in the databases and providers’ related tools.

Role Responsibility

  • Create medical providers in the database in accordance with company’s’ rules that ensure an accurate and timely processing of claims.
  • Work with the Health & Benefits Team and other areas of the organization to make sure that the company’s guidelines regarding providers’ data and information management are up to date and followed by all the stakeholders in the organization.
  • Ensure the quality and integrity of providers’ data when searched via operating system, web page, apps or any other tool where providers’ information is displayed to internal or external customers.
  • Identify and implement opportunities to automate and optimize the Health & Benefits processes related to medical providers information, specially the ones related to an efficient claims adjudication process.
  • Coordinate with IT department a periodic clean-up of the providers’ database in order to avoid misunderstanding due to duplicate records, inaccurate provider contact or banking information, misspellings or any other cause of potential error.
  • Perform an audit trail of authorized users for the creation, edition, and deletion of providers in the databases and eliminate and avoid the unauthorized use of user’s privileges.
  • The Ideal Candidate

  • Bachelor’s Degree in Industrial Engineering, Systems Engineering, Information Technology or related field is required.
  • 3-4 years of experience in the service industry (i.e. healthcare, insurance, hospitality, etc)
  • 1 year experience in Latin America in a technology or manufacturing sector working with database management.
  • Basic knowledge of medical terminology is preferred.
  • Advance knowledge of Microsoft Excel, Access, and PowerPoint is required and intermediate knowledge of Microsoft Office Suite is required.
  • Knowledge of Tableau, ClickView, SQL, SAAS or any reporting and / or visualization tool.
  • Bilingual in English and Spanish with the ability to speak, read and write effectively in both languages is required.
  • Excellent analytical, organizational, prioritizing, time management, and multi-tasking skills.
  • Strong customer service skills and rapport building skills with the ability to interact with providers and internal customers in a professional, diplomatic and tactful manner.
  • Ability to constantly achieve a positive customer experience and build a relationship with providers with every interaction.
  • Self-motivated and able to work under own initiative while working effectively within a team.
  • Bupa

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