Company Description
About Kaelo
Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa – products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.

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.
KEY OUTCOMES (not limited to) Level 4 and 5 process elements
Management of Multi-disciplinary Network:
Establish and maintain a Provider Network to serve patients in accordance with contractual obligations with medical schemes, insurance and primary care products.
Ensure all required documentation is obtained from the provider prior to activating the contract
Train providers in keeping with Prime Cure services, policies and procedures
Develop and implement sound administrative, communication and operational systems to ensure consistent service delivery
Set work standards and ensure that these standards are met
Implement quality assurance procedures within the provider network
Resolve queries between funders, Prime Cure and service providers.
Ensure all interactions with providers are documented and SOP’s are followed
Traveling may be required to visit for elite and contravening practices
Service level agreement management:
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
Ensure all provider details are kept up to date on MIP and provider lists
Reporting:
Compile daily, monthly, quarterly and ad hoc reports with precision and quality and submit these internally and externally at the agreed deadline dates for providers allocated to you
Collect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executive
Complete quality audits monthly on all network related SOP’s
Provide reporting on engagement with providers
Use of data to effectively identify and engage non-performing sites

Qualifications
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 3 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
Computer Literacy – Microsoft Excel, Word and Power Point
Strong phone, email (written) and inter-person communication skills
PREFERRED
Strong Knowledge of Medical Scheme Industry (Optom , Pharmacy , Dental , GP , Hospital)

Additional Information

• 
  Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manage complexity
• Problem solving skills
• Decision thinking
• Encourages engagement
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Purpose driven
• Significance and values orientated