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South Africa

Manager Provider Administration

Company Medihelp
Reference # Sandra Minne
Published 22/07/2021
Contract Type Permanent
Salary Market Related
Location Pretoria, Gauteng, South Africa
Introduction
The position will become vacant due to a resignation
Job Functions Administration
Industries Insurance
Specification

Responsible for provider administration through the following actions:

Administration and maintenance of provider networks, which includes processing new contracts, terminating contracts, and handling queries regarding network contracts;

Management of the different service provider networks;

Management of the capitation and service provider agreements; and

Geo-mapping of providers in a network

Oversee the maintenance and update processes of supplier information and approve supplier banking details

Responsible for quality control of all tasks performed in the division, including maintenance of the standard operation procedures.

Improvement of network related systems and utilization of digital platforms to communicate networks to members

Draft, review and negotiate contracts with third-party service providers to ensure delivery of services required.

Ensure constant operational efficiency and improvement of processes through innovation within areas under control.

Ensure adherence to all legislative and regulatory prescripts.

Continuously evaluate operational plans, actions and resources to ensure that objectives are achieved.

Manage the budget in order to utilise resources effectively and achieve objectives.
Requirements

Grade 12 and a relevant tertiary diploma.

Six years’ relevant experience, of which at least two years should be in a senior supervisory capacity.

Must possess knowledge of the following:

Medical Schemes Act;

Rules and benefit structures;

Prescribed minimum benefits; and

Functioning of supplier networks.

Computer literate in MS Office.

Must possess a valid K53 driving licence.

Leadership competencies – delivering results and continuous improvement.

Core competencies – communicating with impact, customer focus and planning & organising.

Enabling competencies – numerical reasoning and data analytics.

Must be able to communicate and negotiate in the best interest of the scheme.
Job Closing Date 28/07/2021
   
   
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Last Updated: 30-6-2021 [21.06.02.21]
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