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Team Leader: Provider Relations

3 months ago

Cape Town, Western Cape, South Africa Health Solutions Full time

Introduction

  • Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
    Role Purpose
  • Lead and manage the provider relations claims team to resolve client queries and process claims aligned to business expectations and aligned to desired client experience

Requirements:

  • Matric or equivalent (essential)
  • Relevant GEMS product training (advantageous)
  • Relevant Claims / Workflow systems and processes (essential)
years' experience in Claims management (advantageous)
years' people management experience (essential)

  • Experience in the Medical Aid related industry (essential)
  • Sound knowledge of Claims policies, procedures and processes.
  • Technical knowledge of Claims processes, Clinical Practices and Medical Terminology
  • Sound knowledge of business products, rules and legislation (Healthcare Compliance Regulations, Governance Principals and Risk Management Strategies to minimise potential liabilities)


 Computer Literacy
  • MS Office: Work, Excel, Outlook and other businessspecific software
  • Knowledge of staff performance metrics

Duties & Responsibilities

Internal Processes

  • Manage, monitor and control the Claims team's delivery on Service Level Agreements made with clients.
  • Manage, monitor and control the team's execution of client claims and queries.
  • Act as an escalation point to assist Claims team addressing client queries.
  • Ensure team's adherence to correct procedure when following up on queries.
  • Analyse the Claims Administration processes and identify opportunities for improvements; implement improvements within the Claims team.
  • Identify and report process and system failures and enhancements to improve client experience.
  • Investigate client queries within the agreed service level and ensure that client receives timeous feedback.
  • Escalate client queries to the relevant department or stakeholder.

Client

  • Provide accurate information and advice to clients and stakeholders in order to ensure that the client receives the appropriate after sales services.
  • Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets.
  • Provide authoritative, expertise and advice to clients and stakeholders.
  • Build and maintain relationships with clients and internal and external stakeholders.
  • Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
  • Make recommendations to improve client service and fair treatment of clients within area of responsibility.
  • Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

People

  • Develop and maintain productive and collaborative working relationships with peers and stakeholders.
  • Positively influence and participate in change initiatives.
  • Continuously develop own expertise in terms of professional, industry and legislation knowledge.
  • Contribute to continuous innovation through the development, sharing and implementation of new ideas.
  • Take ownership for driving career development.

Finance

  • Contribute to the financial planning process within area.
  • Identify opportunities to enhance cost effectiveness and increase operational efficiency.
  • Manage financial and other company resources under your control with due respect.
  • Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

Competencies

  • Analytical
  • Customer Services
  • Client Relations
  • Conflict Management
  • Communication
  • Data Analysis
  • Written and Verbal Communication
  • Problem Solving
  • Leadership
  • Decision Making
  • Collaboration and Teamwork
  • Planning and Organising skills
  • People Management
  • Interpersonal skills
  • Reporting