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Johannesburg: Specialist Network Provider Manager

Johannesburg: Specialist Network Provider Manager

Posted on 2025-05-22 00:00:00

Employer Unspecified
Category Accounting / Finance
Location Gauteng  / Johannesburg

Job Summary

Requirements: Diploma or Degree (NQF Level 5 or higher) 12 years of relevant experience, preferably in healthcare or insurance Strong interpersonal, negotiation, and communication skills Knowledge of healthcare regulations, claims processing, and contracting Analytical, organized, detail-oriented, and able to manage multiple tasks Proficient in MS Office and basic computer applications Responsibilities: Provider Network Management: Build, negotiate, and maintain a network of medical specialists. Handle contracts, rate negotiations, and provider communications. Strategy & Analysis: Identify gaps in provider networks and implement strategies to enhance efficiency and coverage. Monitor return on investment of network initiatives. Claims & Risk Management: Oversee claims processes to ensure compliance with agreed terms. Resolve provider disputes and discrepancies. Performance Monitoring: Track provider performance and key metrics. Report outcomes and recommend improvements. Compliance & Quality Assurance: Ensure providers follow relevant regulations and quality standards. Conduct audits and stay updated on industry regulations. Customer Service & Support: Act as a main contact point for providers, addressing queries and concerns professionally. Training & Development: Educate network providers on procedures, standards, and updates.

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