Insurance Provider Networks Manager | Belmar Personnel

Qualification Required:

• Matric
• Bachelors Degree
• FAIS Compliant
• Valid Driving License
• Customer Service Certificate (advantageous)

Skills and Experience:

• A minimum of 6 years experience in the South African healthcare market
• A minimum of 3 years experience in a similar/related position Healthcare Provider Network Management
• Solid negotiating skills
• Developing, maintaining, and managing stakeholder relationships in the private and public sector
• Works independently and with minimal supervision
• Highly confident and professional
• Ability to make judgment calls and utilising proper discretion
• Excellent oral and written communication skills
• Excellent customer service and sound computer skills
• Ability to handle pressure – always remain calm, friendly, courteous, polite, professional, and willing to assist

Scope of Responsibility:

• Lead and motivate Provider Networks team
• Working on multiple projects
• Collaborating with key stakeholders and departments to ensure efficacy

• Ensuring that the healthcare provider network composition includes an appropriate distribution of providers
• Managing, negotiating, executing, reviewing, and analysing, the dispute resolution processes in line with company standards
• Maintaining and enhancing healthcare provider networks while meeting and exceeding accessibility, quality, financial goals, and cost initiatives

• Participating in cross-functional teams to develop new, enhanced systems processes, programs, and policies to support business needs
• Initiating and implementing action plans to increase quality and productivity
• Developing and managing relationships across the Unity Health provider networks including general practitioners, dental practitioners, pharmacies, radiologists, pathologists, optometrists, emergency services, hospital groups (private and public), and independent out-patient casualty units

• Working with management to set and agree on various provider fee structures to be used in the provider arrangements/agreements
• Implementing and managing the renewal of fee structures for providers
• Managing, reviewing, and implementing contractual documentation as and when required

• Creating and adhering to various Standards of Practice (SOPs) in setting up of new provider arrangements and managing them thereafter
• Onsite visits to potential/new providers to set up agreements as may be determined by their membership or other requirements
• Negotiating, developing, and managing healthcare provider arrangements
• Displaying confidence and professionalism during onsite and remote presentations on benefits and products on offer to clients and providers in the professional realm
• Ensuring provider network data integrity
• Demonstrating accuracy and due diligence for administrative and other business purposes
• Any other duties as assigned by the company from time to time