Job Description

Job Advert Summary

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.

Minimum 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

Duties and Responsibilities

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