Posted on: 13 October 2023
ID 888564

Provider Networks Consultant - Remote

A remote work oppotunity available for a Provider Network Consultant in an insurance company. The role involves extensive travel across the following 4 provinces, Western Cape, Free State, Eastern Cape and Northern Cape.

Responsibility
  • Developing integrated networks with quality medical providers yielding a geographically competitive, accessible, stable network that achieves company objectives
  • Evaluating medical practices for member care, and trend quality compliance at the provider level
  • Developing 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
  • Negotiating all Provider Network, casualty, and Hospital contracts on an individual basis and or in groups.
(IPAs and discipline-specific groups) where appropriate
  • Partnering with internal stakeholders to create a seamless experience for providers
  • Ensure all enquiries are resolved satisfactorily and customer requirements within business rules are met
  • Continuously managing risk of all providers and acting in areas where costs are exuberant
  • Identifying and resolving network access gaps or perceived gaps
  • Supplying monthly management reports
Qualifications
  • Matric
  • Diploma
  • Regulatory Exams - RE05 - Preferred
Skills And Experience
  • Bi-Lingual
At least three (3) years of experience in a similar role
  • Sound understanding of the South African Health industry, plan options, and benefits, etc.
  • Business Reporting skills
  • 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.
  • Good experience in collaborating with all medical provider types and, understanding how medical providers administration systems work, for claims to be submitted
  • Working knowledge of behavioural health provider operations and analytical skills to resolve provider issues
  • Excellent oral and written communication skills
  • Computer literate - MS Office suite, i.e., Word and Excel necessary
  • Intermediate understanding of claims risk profiling
  • This position requires extensive travelling and the ability to travel to different provinces to visit providers.
Occupation:
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