Senior Network Vendor Manager

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Effectively manages competitive and complex contractual relationships with TPAs and/or business partners in Europe, APAC, Africa and Middle East excluding Americas region in support of international network, medical cost management and overall claim/customer service strategies. Provide concierge level of service to our members via timely provision of required network access and proactive management of network relationships to ensure seamless direct settlement access.

Job Responsibilities:

• Manage TPA relationship with external vendors and own overall relationship with assigned TPAs in Europe, Africa, Middle East and APAC region.
• Oversee and manage contractual relationship with assigned TPA(s).
• Manage Third Party Risk Governance process for your assigned TPA(s).
• Manage ongoing Aetna compliance review process for your assigned TPA(s).
• Manage monthly billing / submission of TPA invoices for timely payment
• Ensure TPA networks are timely reviewed and uploaded on internal Aetna systems.
• Ensure TPA guides, country guides and other internal materials are timely updated and up to date.
• Ensuring streamline member experience at each country level. Evaluate network options, network efficacies and optimize network utilization to increase direct billing.
• End to end ownership of operational issues originating from assigned TPAs and work towards swift resolutions.
• Effectively negotiates and manages complex, competitive contractual relationships with providers/vendors according to prescribed guidelines in support of global and regional network strategies. Expand International provider network by contracting new direct pay providers and manage overall contracting process.
• Act as a Subject matter expert to assist internal sales, account management and sales support team on network and TPA questions / inquiries. Support sales as a subject matter expert on external broker / client calls.
• Oversee and manage any operational issues and queries regarding your assigned TPA(s).
• Manage day to day provider operations, either direct or through network business partners. Ensures operational efficiency for all network processes and infrastructure through proactive provider education and collaboration with Aetna International Service Operations
• Executes regional-specific strategies and tactics in response to market expectations
• Executes client-specific strategies and tactics for key expatriate clients.
• Responsible for understanding and managing medical cost issues and initiating appropriate action from the provider perspective
• Key contributor to enhanced provider service solution like provider portal and other digital solution, including development and/or management of process and technical support.
• Initiate legal reviews as needed; ensure all required reviews completed by appropriate functional areas

• Benefits Management/Interacting with Medical Professionals
• Strong project management skills
• Prior client facing experience.
• Managing vendor relationships
• General Business/Demonstrating Business and Industry Acumen
• Sales/Managing Competitive Networks

• Leadership/Fostering a Global Perspective
• Health Insurance understanding / business negotiations
• Service/Demonstrating Service Discipline

• Bachelors degree preferred or a combination of professional work experience and education.