Provider Relations and Wellness Coordinator

Role Overview

The Provider Relations and Wellness Coordinator is responsible for fostering strong partnerships with healthcare providers to ensure effective service delivery to members while initiating and managing wellness programs that improve health outcomes and mitigate long-term claims expenses. This position integrates operational provider engagement duties with the creation and execution of preventive health initiatives.

Key Responsibilities

• Establish and sustain solid relationships with healthcare providers.
• Negotiate pricing structures including tariffs, discounts, and service packages.
• Address and resolve provider-related concerns promptly to maintain operational fluidity.
• Perform routine audits and compliance assessments of service providers.
• Serve as the primary escalation contact for provider issues and oversee provider onboarding processes.
• Design and implement wellness programs such as health screenings, corporate wellness initiatives, awareness campaigns, and digital wellness platforms.
• Advocate preventive care to lower claims costs and enhance member health status.
• Monitor participation rates and evaluate the impact of wellness programs.
• Collaborate with corporate clients to co-develop customized wellness strategies.
• Collaborate with the underwriting team to assess health risks from proposal forms.
• Facilitate enrollment of members in chronic disease management schemes.
• Coordinate efforts with claims, care management, finance, and customer service departments to ensure alignment between provider relations and wellness activities.
• Provide management with insights regarding provider performance, utilization trends, and wellness results.
• Support marketing and client service teams through provision of relevant provider and wellness information.
• Maintain accurate documentation of provider contracts and wellness program activities.
• Ensure adherence to applicable regulatory, ethical, and data protection standards.
• Generate regular reports covering provider relations, cost management, and wellness program effectiveness.
• Uphold high standards of ethics, confidentiality, and integrity in managing health data and client details.

Core Competencies

• Exceptional skills in managing relationships and engaging diverse stakeholders.
• Strong verbal and written communication proficiency.
• Analytical aptitude and problem-solving abilities.
• Integrity, confidentiality, and adherence to ethical codes.
• Capacity to influence stakeholders and champion change.
• Proactive approach with an innovative, results-focused mindset.

Required Knowledge and Skills

• Thorough knowledge of healthcare delivery systems and health insurance operations.
• Clinical knowledge and competence.
• Negotiation expertise pertinent to healthcare agreements.
• Strong analytical and quantitative skills for validating claim costs.
• Proficiency in MS Office applications and claims management software.
• Ability to identify irregularities or possible fraudulent activities.
• Experience in designing and implementing wellness programs.

Educational Qualifications and Experience

• Bachelor’s degree or diploma in Nursing, Clinical Medicine, Public Health, Health Sciences, Healthcare Management, or related discipline.
• Valid registration and practicing license from relevant professional bodies such as the Nursing Council of Kenya, Clinical Officers Council, or Pharmacy and Poisons Board.
• Certification or training in wellness, preventive healthcare, care management, or chronic disease management is advantageous.
• Additional training in health insurance, claims management, or medical underwriting is beneficial.
• Minimum of three to five years’ experience in healthcare provider relations, medical insurance, care management, wellness coordination, clinical operations, or related sectors.
• Experience collaborating with healthcare providers, corporate clients, members, and insurance operations preferred.

Application Details

Interested candidates should submit their CVs along with academic and professional certification copies quoting the Job Reference Number and position. Applications must include current gross salary and expected monthly pay. Deadline for applications is 21st July 2026.