September 30, 2022

Supplier network consultant – IT-Online

Our client in the field of health insurance is looking for a provider network consultant in the KZN region.

Responsibility:

  • Develop integrated networks with quality providers producing a geographically competitive, broadly accessible and stable network that achieves business objectives.
  • Assess member care analysis practices and trending quality compliance at the provider level.
  • Develop action plans and programs to support supplier practices in continuous quality improvement using approved guidelines.
  • Responsible for vendor training, contract compliance, and resolving vendor concerns and issues
  • Negotiate all supplier, accident and hospital network contracts on an individual and/or group basis
    (IPA and discipline-specific groups) where applicable.
    Collaborate with internal stakeholders to create a seamless experience for suppliers.
  • Ensure that all inquiries are satisfactorily resolved and that customer requirements within business rules are met.
  • Ongoing risk management of all suppliers and taking action in areas where costs are exuberant.
  • Identify and resolve network access gaps or perceived gaps.
  • Provide monthly management reports.

Qualifications:

  • Matrix
  • Compliant FAIS
  • RE 5 and business category
  • Valid driver’s license

Skills and experience:

  • At least 2-5 years of experience in a similar role
  • Good understanding of the South African healthcare industry, options, benefits, etc.
  • Ability to develop interpersonal business relationships with network vendors and internal business partners leading to high vendor and member satisfaction.
  • Achieve regulatory goals and requirements.
  • Must have experience working with all types of vendors and understand the logic of how vendor administration systems work for claims to be submitted.
  • Must have a working knowledge of behavioral health provider business operations and analytical abilities to troubleshoot provider issues.
  • Excellent oral and written communication skills
  • Computer skills – MS Office suite, ie Word and Excel required.
  • A good understanding of claims risk profiling.
  • This position requires extensive travel.
  • Possibility to travel to all service providers.

Desired skills:

  • Healthcare insurance
  • MS Office

Desired work experience:

About the employer:

One of the leading health insurers in South Africa

Find out more/Apply to this position