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    • Networks Outbound Manager - Johannesburg - Kaelo

    Kaelo
    Kaelo Johannesburg

    4 days ago

    Default job background
    Description
    The Networks Outbound Manager is responsible for the 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 and implementation of standards and implement, manage, and maintain quality assurance. Query resolution and effective interaction management. Manage contracts and service level agreements, through effective reporting and administration. Assisting our Network by educating them on our benefits, processes, and systems.


    Skills and Experience:
    Sound understanding of the South African Health industry, options, benefits, etc.


    Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.

    Meeting targets and regulatory requirements

    Must have experience in working with all provider types and understand the logic as to how providers' administration systems work for claims to be submitted

    Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues

    Knowledge of The Protection of Personal Information Act (POPIA) and the ability to apply this in day-to-day functions

    Computer literate – Intermediate MS Office a must

    MIP System experience


    Scope of responsibility:
    Developing, maintaining, and managing stakeholder relationships in the private and public sector

    Working on multiple projects

    Collaborating with key stakeholders and departments to ensure efficacy

    Ensuring that the healthcare provider network composition includes an appropriate distribution of providers

    Maintaining and enhancing healthcare provider networks while meeting and exceeding accessibility, quality, financial goals, and cost initiatives

    Participating in cross-functional teams to develop new, enhanced systems processes, programs, and policies to support business needs

    Initiating and implementing action plans to increase quality and productivity

    Developing and managing relationships across the provider networks – including general practitioners, dental practitioners, pharmacies, radiologists, pathologists


    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


    SPECIAL REQUIREMENTS
    Ability to maintain confidentiality, problem solve, negotiate and communicate


    PERSON DETAILS:

    WORK EXPERIENCE

    REQUIRED
    Works independently and with minimal supervision

    Ability to make judgment calls and utilising proper discretion.

    Excellent oral and written communication skills

    Excellent customer service and sound computer skills

    Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.


    PREFERRED
    Proven work experience as a client or provider Management role

    A minimum of 6 years' experience in the South African healthcare market


    EDUCATION:

    QUALIFICATIONS:

    ACCREDITATIONS WITH PROFESSIONAL BODY

    REQUIRED
    Matric

    FAIS Compliant

    RE 5 and Class of Business

    Valid Driving License


    TECHNICAL SKILLS OR KNOWLEDGE

    REQUIRED
    Computer Literacy – Microsoft Excel, Word and PowerPoint

    Strong phone, email (written) and inter-person communication skills.


    PREFERRED
    Knowledge of Medical Scheme Industry

    MIP and Putty knowledge would be an advantage.

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

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