Manager: Provider Relations at Momentum Metropolitan Holdings Limited

Role Purpose    

• Take accountability for key Provider Engagement functions and as a result ensure that MH continues to efficiently and effectively provide leading administrative services to the Scheme and its Providers
• Maintain, manage, build and nurture strategic relationships with and between MH, the Scheme, Service providers, Bureaus, Societies as well as Service Provider Networks (SPNs)
• Support the Scheme’s Provider Relations strategy
• Facilitate effective and efficient business systems and processes within the broader MH
• Review and propose enhancements to existing business processes
• Ensure Scheme benefits, rule and processes are understood and applied by Service providers
• Manage the smooth functioning of a comprehensive Provider Relations department, which includes regular interaction with Business Partners and Suppliers of Service (Internal and External)
• Provide clear and consistent communication to staff and stakeholders
• Provide proactive and strategic input to our client on claims trends identified through insightful analysis and interpretation
• Support and implement company Transformation objectives
• Efficient and effective management and leadership of staff to promote and maintain the objectives of the department
• Manage performance of staff within the expected levels of their job descriptions
• Maintain relevant and updated job descriptions
• Determine appropriate staffing levels within the Operations department, taking cognizance of constant growth
• Develop and nurture staff to achieve individual potential
• Provide clear succession plans for all key positions within the department
• Conduct regular one-on-one sessions with direct reportees
• Provide guidance, coaching and mentoring to employees reporting to this portfolio
• Conduct Performance Reviews in line with MH Performance Excellence process
• Embark on training initiatives to address skills gaps identified within the department
• Recommend and implement quality initiatives and improvements, based on outcomes of root cause analysis (RCA), to enhance service delivery
• Promote and maintain MH values within the department
• Adhere to departmental budget and ensure effective and efficient management thereof

Requirements    

• Matric
• Business related degree – Customer Relations, Management, Business Management, Project Management, Operations Management
• 6 – 8 years medical aid industry experience
• 3 – 4   years  Claims experience within the medical aid industry
• Thorough knowledge of claims processing (technical aspect)
• Good product understanding of GEMS as well as the Medical Schemes Act
• Excellent verbal and written communication as well as presentation skills
• Ability to work independently and analyse work situations and initiate corrective action
• Understanding and knowledge of the interpretation and application of the various industry bodies, i.e. Societies,  CMS, DoH, BHF, Bureaus, Private hospital groups, etc.

Duties & Responsibilities    
Relationship Management

• Contribute to the development of a Client Value Proposition (CVP) and client service strategies to ensure that operational objectives are incorporated
• Deliver meaningful and relevant reporting on operations and client services functions and trends as required
• Act as communication channel between MH, the Scheme, Key providers
• Attend meetings with key providers and provide regular feedback on the status of their queries – pro-active approach to the servicing needs of the key provider together with monthly reporting on analysis of enquiries/complaints received
• Building and maintaining relationships with clients and key personnel within the providers
• Conducting business reviews to ensure clients are satisfied with the Scheme and services
• Inform the key provider about changes within the Scheme
• Attending meetings with key providers to build relationships
• Achieving client relationship targets and KPI’s
• Carrying out key provider satisfaction surveys and reviews
• Monitoring business performance against service level and flagging potential issues
• Maintain and update key provider records and notify Management accordingly
• Liaising with internal departments to ensure key provider’s  needs are fulfilled effectively

Client Services

• Manage a comprehensive client service function, ensuring timeous and accurate service delivery
• Provide authoritative expertise and advice to clients and stakeholders
• Deliver on agreed service agreements made with key providers and internal and external stakeholders in order to ensure that client expectations are managed
• Make recommendations to improve client service experience and fair treatment of clients – based on analysis (RCA/complaints/enquiries)
• Improve on delivery of work methods and procedures/processes
• Identification of training and development needs to ensure continuous improvement within the organisation
• Attending weekly operational meetings with management to discuss progress on key providers’
• Investigations, perform RCA , analyse the outcomes and make recommendations on corrective action
• Manage projects that has been identified through the RCA and analysis
• Ensure accurate and timeous reporting on weekly activity and performance
• Manage correspondence resulting from investigations (written/e-mail/telephonic/fax)

People

• Develop and maintain productive and collaborative working relationships with peers and stakeholders
• Positively influence and participate in change initiatives
• Continuously develop own expertise in terms of professional, industry and legislation knowledge
• Contribute to continuous innovation through the development, sharing and implementation of new ideas
• Take ownership for driving developmental areas
• Participate and contribute to a culture which builds rewarding relationships, in line with the values of the MMH
• Facilitates feedback and provide exceptional client service

Finance

• Contribute to the financial planning process within area – travel scheduling
• Identify opportunities to enhance cost effectiveness and increase operational efficiency
• Manage financial and other company resources under your control with due respect
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum, i.e. fraudulent or wasteful providers

Competencies    
Business Acumen

• Thorough understanding and knowledge of MH operational processes that includes, but not limited to:
• Risks to the business as well as key drivers that contribute to the success of the business (Group)
• Good understanding of Claims - process and technical
• Ensure that the pursuit of excellence and delivering on outstanding client centric service is paramount when delivering our services
• Have sound technical knowledge and ability in terms Claims
• Client/Stakeholder Commitment
• In constant pursuit of exceeding the needs of the Client, (Scheme, Members, Service providers, Societies, Bureaus as well as SPNs and business partners), create long and lasting relationships that fully supports all partners in and within the value chain

Collaboration

• Network and aligning the Provider Relations objective (in collaboration with the greater BU objectives/Scheme) so that there is a mutual and parallel outcome that positively meets the expectations and needs of all parties involved

Impact and Influence

• Persuade, convince, influences and inspires others, within MMH and externally to win support, loyalty and gain commitment to the purpose of MMH/Scheme
• Drive for Results
• Always,  with the Client, it’s Members and the Service providers in mind, provide accurate and efficient feedback and service that is underpinned by accountability and proficiency

Leads Change and Innovation

• Identify enhancements/improvements to the service delivery and administration processes/SOPs, etc. to promote and drive continuous improvement through innovation.
• Motivating and Inspiring Team
• Create and maintain an open, positive working environment by promoting commitment, building trust, a shared sense of purpose, and empowerment in others and encouraging them to contribute to the best of their ability.

Strategic Thinking

• Create innovative methods of ensuring that Bureaus take on more responsibility  for their claims processes; inclusive of enquiries, recons, Auth updates, PMB cases, etc.

Self-Awareness and Insight

• Manages self and relationships with others effectively
• Provide proactive support and perspective in difficult situations 

Diversity and Inclusiveness

• Display sensitivity to individual and cultural similarities and differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.

Growing Talent

• Take responsibility for own development, actively mentor, coach and develop talent in others
• Build leadership capabilities by providing opportunities and experiences to develop skills, competencies and business knowledge