RelianceUnited - a subsidiary of Unilab

HDSI: Provider Relations Manager

RelianceUnited - a subsidiary of Unilab  •  Mandaluyong, PH (Onsite)  •  6 hours ago
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Job Description

Job Objective / Purpose

To provide end-to-end medical, operational, and strategic oversight across claims adjudication, provider management, accreditation, and internal medical support—serving as a critical bridge between Clinical, Customer Service, Finance, and Provider Networks.

Duties and Responsibilities

  • Lead provider engagement initiatives (planning, organizing, and execution)
  • Approve/deny reconciliation of accounts impacting provider payments
  • Perform in-patient adjudication, including proper segregation of illnesses
  • Review and approve facility accreditation and any changes
  • Handle and resolve Customer Service (CS) medical concerns and escalations
  • Review and evaluate contracts (providers)
  • Screen, accredit, and onboard CCM and clinic management doctors
  • Monitor PROs’ KRAs and overall performance
  • Initiate and support NetSuite PRT module upgrades (medical validation and process alignment)
  • Attend to medical needs of Flexicare employees
  • Provide real-time medical guidance to CSRs
  • Analyze utilization data and provide strategic recommendations to management
  • Diagnose and adjudicate claims to ensure accuracy and cost control
  • Ensure coordination across departments and business units for seamless operations
RelianceUnited - a subsidiary of Unilab

About RelianceUnited - a subsidiary of Unilab

In line with its vision to provide customers Trusted Quality Healthcare and delivering better value to its partners and customers, United Laboratories (UNILAB), the leading Pharmaceutical company in the Philippines and South East Asia, established RelianceUnited.

RelianceUnited's mission is to deliver simpler and better outpatient healthcare solutions.​

RelianceUnited is a holding company of the following subsidiaries:

HealthFirst Clinic - A growing network of premier multi-specialty clinics offering convenient and quality out-patient health care services from pre-employment services, annual physical check-ups, executive health packages, dental services, to a comprehensive Women’s Health Center, An ambulatory surgical center that can do various outpatient procedures and Dialysis Centers.

Flexicare - A health benefit management company which has close to 20 years’ worth of experience in managing healthcare benefits as well as providing comprehensive industrial clinic services.

ActiveOne Health - A leading corporate clinic and wellness services management company in the Philippines, ActiveOne has been dedicated to offering premium health services to premium institutions.

Industry
Government & Public Safety
Company Size
51-200 employees
Headquarters
Mandaluyong City, PH
Year Founded
Unknown
Website
relianceunited.com
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