Job Description

Company Description

About Kaelo
Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa xe2x80x93 products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.



The Outbound Relationship Specialist is responsible for the management of the multi-disciplinary network. Ensuring that contractual obligations with medical schemes, insurance and primary care products are established and maintained. Maintaining strong relationships and implementation of standards and implement, manage, and maintain quality assurance. Query resolution and effective interaction management. Manage contracts and service level agreements, through effective reporting and administration. Assisting our Network by educating them on our benefits, processes, and systems.

KEY OUTCOMES (not limited to) Level 4 and 5 process elements

Skills and Experience:

Sound understanding of the South African Health industry, options, 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 providersxe2x80x99 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

Knowledge of The Protection of Personal Information Act (POPIA) and the ability to apply this in day-to-day functions

Computer literate xe2x80x93 Intermediate MS Office a must

MIP System experience

Scope of responsibility:

Developing, maintaining, and managing stakeholder relationships in the private and public sector

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

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 provider networks xe2x80x93 including general practitioners, dental practitioners, pharmacies, radiologists, pathologists

Reporting:

Compile daily, monthly, quarterly and ad hoc reports with precision and quality and submit these internally and externally at the agreed deadline dates for providers allocated to you

Collect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executive

Complete quality audits monthly on all network related SOPxe2x80x99s

Qualifications

SPECIAL REQUIREMENTS

Ability to maintain confidentiality, problem solve, negotiate and communicate

PERSON DETAILS: WORK EXPERIENCE

REQUIRED

Works independently and with minimal supervision

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.

PREFERRED

Proven work experience as a client or provider Management role

A minimum of 6 yearsxe2x80x99 experience in the South African healthcare market

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

Matric

FAIS Compliant

RE 5 and Class of Business

Valid Driving License

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

Computer Literacy xe2x80x93 Microsoft Excel, Word and PowerPoint

Strong phone, email (written) and inter-person communication skills.

PREFERRED

Knowledge of Medical Scheme Industry

MIP and Putty knowledge would be an advantage.

Additional Information

• Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manage complexity
• Problem solving skills
• Decision thinking
• Encourages engagement
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Purpose driven
• Significance and values orientated

Kaelo