Medical Network Specialist Position Available In Miami-Dade, Florida
Tallo's Job Summary: BMI Companies is seeking a Medical Network Specialist to build and maintain a high-quality network of medical providers in the U.S. This role involves managing relationships, ensuring compliance, negotiating rates, and coordinating with providers to enhance healthcare services for insured members. Qualifications include a Bachelor's degree in a medical field, RN certification, and 3-5 years of experience in life and health insurance.
Job Description
BMI Companies, part of BMI Financial Group, has nearly five decades of experience providing insurance and solutions for families worldwide. Specializing in high-quality Life Insurance, Health Insurance with global coverage, and Travel Assistance Plans, BMI is committed to innovating insurance products for the international community. About the
Role:
The purpose of this position is to structure, develop, and maintain a high-quality network of medical providers specifically in the United States and local regions, ensuring accessibility and efficiency of services for insured members. He/ She will be responsible for building and managing relationships with medical providers, ensuring compliance with regulatory requirements, and supporting the development of a cost-efficient and accessible healthcare network. Evaluate the existing network of medical providers and actively search for and recruit new providers. Establish and maintain business and operational relationships with hospitals and medical providers. Perform timely follow-up with providers regarding the update of legal documents (operating permits, accreditations, legal documents, etc.). Coordinate periodic training on authorization processes, operational processes, billing methods, and provider management. Negotiate competitive rates that contribute to the management of claims costs. Provide follow-up on claims and various requirements from insured members. Coordinate payment reconciliations with local offices. Structure a network of providers with all its components (air ambulances, license verification, permits, evacuation plans, and negotiating prices when necessary). Negotiate additional discounts for high-cost cases in the United States. Support the Corporate Medical Network Director on specific projects such as (but not limited to) cancer care, electronic invoicing, and the implementation of PROM (Patient Reported Outcomes). Will be responsible for onboarding medical evaluators/providers for new life insurance business in all required countries, as well as maintaining this network.
Qualifications:
Education:
Bachelor’s degree in medical field or health administration Registered Nurse Certification a
PLUS Experience:
Minimum 3-5 years’ experience in the life and/or health insurance business, specifically regarding the operation of medical networks for health and life products. Knowledge of Medical Provider Networks within the U.S. healthcare system, with a focus on ensuring access and efficiency for insured members. Experience with Life EOI (Evidence of Insurability) processes, including exposure to multiple vendors and providers across different regions, ensuring seamless coordination and coverage. Negotiation Skills Effective Communication Skills
