Medical & Partner Management Officer

In this position, your key responsibilities as a member of partner management team will be to develop, manage and steer the relationship with Globality’s service/cooperation partners and secure consistency and adherence to agreed performance targets, including the conducting business reviews and payment oversight._

As a proactive member of the Medical team, you will support cost containment strategies and medical management of cases.

**Responsibilities**

Medical Underwriting
- Evaluate medical risks for new individual and group businesses in line with underwriting guidelines and align with internal stakeholders
- Analyze medical reports
- Develop and maintain the medical underwriting guidelines/processes for both individual and group businesses
- Complement the product development process by providing medical expertise
- Provide internal trainings about medical underwriting
- Decide on Pre-existing checks for facultative contracts/cases from existing policies and communicate appropriate consequences
- Support in planning and implementation of MUW tool

Medical Management
- Checking on medical necessity of the treatments of claims
- Checking pre-existing conditions
- Evaluating medical condition and treatments against benefit coverage
- Advising on reasonability of costs, including guarantee of payments and steering of client for cost optimization
- Examining potential medical frauds
- Preventing unnecessary treatment and over utilization of services by medical providers and clients.
- Conduct medical trainings.
- Create, maintain and publish internal medical guides, training materials to relevant teams as and when needed
- Provide support on Emergency Assistance cases and feedback management when necessary.

Partner Management
- _- _Develop and manage relationship with the allocated service/co-operation partners and secure consistency and adherence to agreed targets, including performance reviews._
- _- _Management of partners in the activities of initiation, maintenance and co-ordination on different aspects of partnerships like contractual, operational, commercial and strategic levels._
- _- _Negotiate, draft and document new service partner contracts and conditions as well as renewal conditions. _
- _- _formulating guidelines / work instructions and conducting audit and sample checks on agreed processes. _
- Excellent verbal and written communication skills in English and in German are required.

**Profile**
- Medical background (e. g. as Doctor or Nurse) or economic / insurance background with medical experience
- Strong ability to effectively assess medical conditions and the associated risks
- Ability to think and work in a multicultural international environment
- Thorough and decisive work attitude with excellent analytical skills
- Experience in partner, TPA & network management at an insurance company would be ideal
- Strong MS Office and data analysis skills.