Provider Relationship Specialist at Kaelo

Job Description

• The Provider Relationship Specialist is responsible for the day to day 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 with DSP’s via periodic engagement and implementation of standards and to manage and maintain quality assurance checks. Query resolution and effective interaction management. Manage contracts and service level agreements, through effective reporting and administration.
• Ensure that each service level agreement is adhered to and met by the relevant business unit owner
• Monitor trends within the business that may adversely affect the SLA and ensure the line manager and relevant business unit owners are kept informed
• Ensure all queries are dealt within contracted SLA all stakeholder are kept informed of relevant progress work items or escalations

KEY OUTCOMES (not limited to)

• Set clear objectives, define roles and responsibilities, and ensure each team member aligns with the team’s vision.
• Communicate expectations, goals and feedback to the group regularly and resolve any concerns or issues actively.
• Identify and address conflicts early, facilitating discussions and finding satisfactory solutions for all parties involved
• Support team members’ professional development by providing opportunities for training and growth.
• Ensure team compliance with company policies and procedures.
• Support, monitor and guide team members to ensure they meet their individual targets and KPIs.
• Generate reports on team performance and provide regular updates to senior management.
• Monitoring overall team performance and maintaining a report. Constantly keeping team members motivated to deliver their best.
• Set the tone for the team and create a positive and productive work environment.
• Developing objectives for the team to work towards and achieve company goals.
• Monitor system performance and report on any system issues that may arise.
• Compile daily stats
• Attend to Escalations from other departments
• Informing senior management and escalating tasks, as necessary.
• Report to the Network Manager

Qualifications

SPECIAL REQUIREMENTS

• Ability to maintain confidentiality, problem solve, negotiate and communicate
• Ability to work in fast paced , High pressure environment
• Valid SA Driving licence

PERSON DETAILS: WORK EXPERIENCE

REQUIRED

• At least 2 years’ experience in the Medical Scheme or Healthcare Administration industry in a client support or provider Management roll

PREFERRED

• Proven work experience as a client or provider Management role

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

• Grade 12 or equivalent NQF 4 certificate

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

• MIP / Putty
• Computer Literacy – Microsoft Excel, Word and PowerPoint
• Strong phone, email (written) and inter-person communication skills

PREFERRED

• Strong Knowledge of Medical Scheme Industry (Optom , Pharmacy , Dental , GP , Hospital)