Provider Network Contract Management - Health Caliberate - Private Health Administrators - Polokwane

Health Calibrate requires well-exeperinced individaul who will act as the key liaison with the healthcare profressional. To develop, maintain and build relationships between stakeholders to support the sustainability of the Scheme. To facilitate product education, share industry knowledge and resolve healthcare professional queries Position Purpose To be the key liaison between Health Calibrate, and the healthcare professional. To develop, maintain and build relationships between stakeholders to support the sustainability of the Scheme. To facilitate product education, share industry knowledge and resolve healthcare professional queries. Accountabilities Client service delivery and quality: Adherence to SOPs and cooperate with peers and leader for best possible service delivery Compliance and Risk Management: Defined legal, statutory and regulatory compliance is maintained at the required standards Operational risk and governance structures, measures and frameworks are complied with; and necessary action is taken to address issues, when necessary Financial Management: Contribute to cost savings within the department to assist with financial goals and targets Operating Model: Provide comprehensive and accurate feedback to clients Identify system constraints and escalate accordingly Ensure that quality control targets are met Meet delivery objectives through working with other team members within and linked to the department / project Resolve operational performance variations and problems and escalate unresolved issues to higher levels Ensure the delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery Operational Implementation of Strategy: Keep up to date with operational changes implemented in response to important external influences Deliver in a manner that supports and meets operational quality standards and meets the defined departmental priorities Perform according to defined operational best practice and identify and implement opportunities for continuous delivery improvement Operational Leadership: Deliver personal performance within Human Capital frameworks and policies to ensure delivery to agreed standards and objectives Engage in development, coaching and mentoring Support transformation through valuing diversity Behave in alignment with the Health Calibrate values Stakeholder Management: Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achieved Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-in Position Specific Outputs Regular engagement with portfolio of healthcare professionals 4 – 5 years' experience interacting with GPs and Specialists and the ability to engage irate clients To ensure the prompt resolution of network Provider queries from various stakeholders (which include other Service Provider Networks (SPN) within agreed Turn Around Time (TAT) Engage with Scheme officials as and when required in the process of resolving escalations Responsible for outbound calls to grow the respective networks Manage the quarterly non-adherence process which involves distribution of non-adherence letters Engagements with non-adherent providers who have been flagged on a quarterly basis Ability to deal with high level escalations and resolution within TAT Provide product education and training on Scheme rules Represent the Scheme at Conferences, Open days and Summits Promote adherence and compliance to contractual terms and conditions Understanding of provider profiling tool – Risk Equalisation Profiling Indicator (REPI 2 ) Ability to ensure quality assurance and strict adherence to departmental Standard Operating Procedures (SOPs) Facilitate Scheme Audit requirements Competency Requirements Attributes: Self-development Interpersonal Sensitivity Telephone etiquette Strategic awareness Adaptability Teamwork Results driven Assertiveness Knowledge: Knowledge of Scheme rules and contractual negotiations Knowledge and application of processes Knowledge and application of relevant legislation Highly proficient in Microsoft Excel and Microsoft Word Skills: Demonstrates Customer Focus Demonstrates Creativity Conflict Management Communication Skills Business Writing Skills Relevant systems knowledge and application Attention to detail and accuracy Good analytical skills Numerical Ability Problem Solving Customer Focus Experience & requirements 4 - 5 years' experience in the medical aid industry, specifically to Network Contract Management and dealing with providers. Must have a valid driver's license Qualifications Matric essential. A Diploma or a degree will be advantageous. MARKET RELATED Apply Now

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Provider Network Contract Management - Health Caliberate - Polokwane

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