Networks Outbound Manager

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 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:

1. Sound understanding of the South African Health industry, options, benefits, etc.
2. Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.
3. Meeting targets and regulatory requirements.
4. 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.
5. Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues.
6. Knowledge of The Protection of Personal Information Act (POPIA) and the ability to apply this in day-to-day functions.
7. MIP System experience.

Scope of responsibility:

1. Developing, maintaining, and managing stakeholder relationships in the private and public sector.
2. Collaborating with key stakeholders and departments to ensure efficacy.
3. Ensuring that the healthcare provider network composition includes an appropriate distribution of providers.
4. Maintaining and enhancing healthcare provider networks while meeting and exceeding accessibility, quality, financial goals, and cost initiatives.
5. Participating in cross-functional teams to develop new, enhanced systems processes, programs, and policies to support business needs.
6. Initiating and implementing action plans to increase quality and productivity.
7. Developing and managing relationships across the provider networks – including general practitioners, dental practitioners, pharmacies, radiologists, pathologists.

Reporting:

1. 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.
2. Collect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executive.
3. Complete quality audits monthly on all network related SOP’s.

Qualifications

SPECIAL REQUIREMENTS

1. Ability to maintain confidentiality, problem solve, negotiate and communicate.

PERSON DETAILS: WORK EXPERIENCE

REQUIRED

1. Works independently and with minimal supervision.
2. Ability to make judgment calls and utilising proper discretion.
3. Excellent oral and written communication skills.
4. Excellent customer service and sound computer skills.
5. Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.

PREFERRED

1. Proven work experience as a client or provider Management role.
2. A minimum of 6 years’ experience in the South African healthcare market.

REQUIRED

1. Matric.
2. FAIS Compliant.
3. RE 5 and Class of Business.
4. Valid Driving License.

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

1. Computer Literacy – Microsoft Excel, Word and PowerPoint.
2. Strong phone, email (written) and inter-person communication skills.

PREFERRED

1. Knowledge of Medical Scheme Industry.
2. MIP and Putty knowledge would be an advantage.