An opportunity exists in the Stakeholder Management team for a Provider Networks Consultant. This role is pivotal in strengthening our provider relationships, enhancing service delivery, and ensuring alignment with our strategic objectives. The successful candidate will serve as a key liaison between the Scheme and healthcare providers, fulfilling the requirements of the schemes, promoting best practices and supporting the development of sustainable, value-based network arrangements.
, Requirements,
- Grade 12 (Matric) essential.
- Business Administration or Commerce Degree will be advantageous
- 3-5 years experience in Medical Scheme Administration or Provider Networks Management.
- Proven track record in stakeholder relationship management.
- Experience in claims or case management is advantageous.
- Strong analytical, reporting, and presentation skills.
- Proficiency in MS Office and digital health platforms.
- Excellent communication and interpersonal skills.
- Self-driven, detail-oriented, and outcome-focused.
- Ability to work independently
- Have diligent work ethics
- Conduct initial provider orientations and ongoing educational outreach.
- Facilitate provider engagement on policies, claims processes, and digital platforms.
- Support the negotiation and implementation of provider agreements, including DSPs and preferred provider arrangements.
- Collaborate with internal teams (e.g., Clinical Risk, Claims, Contracting) to ensure effective communication, processes and escalated enquiry management.
- Analyse provider performance data to inform contracting, reimbursement strategies, network compliance and performance
- Provide Scheme reporting on Provider Networks Management.
- Support the business with strategic requirements that support managed care activities.
- Represent the organisation at stakeholder forums and provider engagements.
- Fulfil various stakeholder engagements as mandated by the head of providers to ensure strategic objectives as agreed with the clients
