Provider Liaison Officer (Cape Town) at Metropolitan

Role Purpose

• To investigate and resolve healthcare provider queries, as per business and client requirement and to successfully maintain relationships with healthcare providers.

Requirements

• Grade 12/Matric
• At least 5 years working experience preferably in the medical scheme industry
• Private medical practice exposure (advantageous)

Duties & Responsibilities

• Act as key contact or providers ensuring continuous and communication and resolution of queries.
• Participate in the review and submission of networks reports.
• Provide substantiated commentary on the quality of network services and provider compliance to the Scheme network agreements.
• Represent the business at forums, committees and stakeholder engagements and promote network participation by healthcare providers.
• Provide substantiated commentary on the quality of network services and provider compliance with Scheme network agreements.
• Educating the external healthcare providers in the business systems.
• Serve as a single point of contact for escalations related to claims and authorization issues from the providers.
• Participate/collaborate with various stakeholders in the provider engagement environment.
• Focus on continuous improvement of service delivery to providers and in turn the members of our clients.
• Build and maintain effective relationships with stakeholders.
• Develop and maintain productive and collaborative working relationships with peers, clients and stakeholders.
• Positively influence and participate in change initiatives.

Competencies

• Business Acumen
• Drive for Results
• Collaboration
• Self-Awareness and Insight
• Client/ Stakeholder Commitment