Provider Networks Consultant

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