Health Care Solutions External Consultant , Kwazulu-Natal

SUMMARY:
Provider Networks Consultant External Sales

POSITION INFO:

A well-established primary healthcare provider in the South African market.  Company mission is to offer primary healthcare insurance solutions to the vast majority of South Africans who are unable to afford medical scheme coverage. We have an opening for a Networks Consultant to join our Networks team who will be the liaison between the company, providers, and members.

The employee will be based at home and then drive to all the different providers that are allocated to him/her. We do not have an office in Durban.

Most of their work hours will be on the road visiting and servicing providers – GP, Dentist, Pharmacy, Hospitals etc.

Qualifications:
• Matric
• Commercial diploma
• FAIS compliant or significant progress towards compliance

Skills and Experience:
• At least 2-5 years experience in a same type of position
• Sound understanding of the South African Health industry, options, and
   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.

Reporting to:
Provider Networks Manager

Scope of 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, trend quality compliance at 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 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.

• Any other duties as assigned by the company from time to time

NB! This job is now closed. You can apply for other jobs by uploading your CV.