Long Term Insurance

Provider Network Consultant -Healthcare

Durban, KwaZulu-Natal
Work Type: Full Time

Our client in the healthcare insurance space is looking for a Provider Network Consultant in the KZN area.


Responsibility:  

•            Develop integrated networks with quality providers yielding a geographically competitive, broadly accessible, stable network that achieves company objectives.

•            Evaluate practices in analysing member care, and trend quality compliance at the provider level.

•            Develop action plans and programs to support provider practices in continuous quality improvement using approved guidelines.

•            Responsible for provider education, contract compliance, and resolving provider concerns and issues

•            Negotiate all Provider Network, casualty, and Hospital contracts on an individual basis and or in groups

(IPA’s and discipline-specific groups) where appropriate.

              Partner with internal stakeholders to create a seamless experience for providers.

•            Ensure all enquiries are resolved satisfactorily and customer requirements within business rules are met.

•            Continuous risk management of all providers and take action in areas where costs are exuberant.

•            Identify and resolve network access gaps or perceived gaps.

•            Supply monthly management reports.


Qualifications:  

•            Matric

•            FAIS Compliant

•            RE 5 and Class of Business

•            Valid Drivers Licence

                            

Skills and Experience:

•            At least 2-5 years of experience in a similar role

•            Sound understanding of the South African Health industry, options, benefits, etc.

•            Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.

•            Meeting targets and regulatory requirements.

•            Must have experience in working with all provider types and understand the logic as to how providers’ administration systems work for claims to be submitted.

•            Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues.

•            Excellent oral and written communication skills

•            Computer literate - MS Office suite, i.e. Word and Excel a must.

•            A good understanding of claims risk profiling.

•            This position requires extensive travelling.

•            Ability to travel to all providers.



Talent Partner:
Misan Idowu
 
Remuneration:
R35,000.00
 

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