Our client in the field of health insurance is looking for a provider network consultant in the KZN region.
- 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.
- 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.
- Healthcare insurance
- MS Office
Desired work experience:
About the employer:
One of the leading health insurers in South Africa
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