Clinical Network Analyst

The Role

The Clinical Network Analyst, Network Governance supports the optimisation, governance, and performance management of the healthcare provider network. The role combines provider network management, provider engagement, claims and utilisation analytics, cost containment, fraud waste and abuse monitoring, and network performance improvement to ensure quality, and accessible and sustainable healthcare services for clients and members.

Key Roles and Responsibilities

Network Management & Engagement (60%)

• Manage relationships with panel clinics, specialists and hospitals to ensure service quality and network sustainability.
• Conduct needs assessments, provider performance reviews and cost-benefit analyses to support network optimisation strategies.
• Recruit, onboard, credential and retain healthcare providers within the panel network.
• Identify service gaps and recommend network expansion or optimisation opportunities.
• Establish service standards and quality expectations for providers.
• Develop and implement provider onboarding, setup and training programmes.
• Liaise with relevant stakeholders to resolve escalated provider-related issues.
• Monitor expenditure utilisation to support departmental budget objectives.
• Support the Account Management team in meeting client expectations and resolving provider-related concerns.
• Track and report key operational and network performance metrics.

Network Governance (40%)

• Analyse claims, utilization, and provider performance data to identify trends, healthcare cost drivers, provider outliers, and network improvement opportunities.
• Identify and investigate potential Fraud, Waste, and Abuse (FWA) risks, and escalate findings appropriately.
• Develop dashboards, reports, and performance scorecards to support governance and business decision-making.
• Generate actionable insights to support healthcare quality improvement, governance and cost containment initiatives.
• Support clinic performance reviews, audits, investigations and healthcare service assessments.
• Monitor provider compliance with contractual, clinical, and operational standards.
• Collaborate with internal stakeholders and healthcare providers to resolve governance and claims-related operational issues.
• Recommend interventions to improve provider performance, healthcare quality and operational efficiency.
• Support governance projects and continuous improvement initiatives assigned by management.
• Perform other duties assigned by the reporting manager.

Requirements

• Diploma or higher qualification.
• Experience in data analytics, healthcare, insurance, third-party administration (TPA), provider network management or medical claims operations preferred.
• Experience analysing healthcare claims, utilisation data or provider performance data would be advantageous.
• Strong analytical, critical thinking and problem-solving skills with high attention to detail.
• Self-motivated and able to work independently while collaborating effectively with cross-functional teams.
• Able to manage multiple priorities in a fast-paced environment.
• At least 1 year of experience in data analysis.
• Strong Excel skills, including pivot tables, lookups, macros, data analysis functions, and reporting. Experience with Power BI or other data visualisation tools is highly desirable.
• Eager to learn

Core Competencies

• Data Analytics & Interpretation
• Provider Network Management
• Stakeholder Management
• Healthcare Cost Management
• Fraud, Waste & Abuse Detection
• Process Improvement
• Communication & Presentation Skills

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