Manager: Provider Relations

2 weeks ago

Cape Town, 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**
- Take accountability for key Provider Engagement functions and as a result ensure that MH continues to efficiently and effectively provide leading administrative services to the Scheme and its Providers
- Maintain, manage, build and nurture strategic relationships with and between MH, the Scheme, Service providers, Bureaus, Societies as well as Service Provider Networks (SPNs)
- Support the Scheme’s Provider Relations strategy
- Facilitate effective and efficient business systems and processes within the broader MH
- Review and propose enhancements to existing business processes
- Ensure Scheme benefits, rule and processes are understood and applied by Service providers
- Manage the smooth functioning of a comprehensive Provider Relations department, which includes regular interaction with Business Partners and Suppliers of Service (Internal and External)
- Provide clear and consistent communication to staff and stakeholders
- Provide proactive and strategic input to our client on claims trends identified through insightful analysis and interpretation
- Support and implement company Transformation objectives
- Efficient and effective management and leadership of staff to promote and maintain the objectives of the department
- Manage performance of staff within the expected levels of their job descriptions
- Maintain relevant and updated job descriptions
- Determine appropriate staffing levels within the Operations department, taking cognizance of constant growth
- Develop and nurture staff to achieve individual potential
- Provide clear succession plans for all key positions within the department
- Conduct regular one-on-one sessions with direct reportees
- Provide guidance, coaching and mentoring to employees reporting to this portfolio
- Conduct Performance Reviews in line with MH Performance Excellence process
- Embark on training initiatives to address skills gaps identified within the department
- Recommend and implement quality initiatives and improvements, based on outcomes of root cause analysis (RCA), to enhance service delivery
- Promote and maintain MH values within the department
- Adhere to departmental budget and ensure effective and efficient management thereof

**Requirements**:

- Matric\
- Business related degree - Customer Relations, Management, Business Management, Project Management, Operations Management
- 6 - 8 years medical aid industry experience
- 3 - 4 years Claims experience within the medical aid industry
- Thorough knowledge of claims processing (technical aspect)
- Good product understanding of GEMS as well as the Medical Schemes Act
- Excellent verbal and written communication as well as presentation skills
- Ability to work independently and analyse work situations and initiate corrective action**Duties & Responsibilities**

**Relationship Management
- Contribute to the development of a Client Value Proposition (CVP) and client service strategies to ensure that operational objectives are incorporated
- Deliver meaningful and relevant reporting on operations and client services functions and trends as required
- Act as communication channel between MH, the Scheme, Key providers
- Attend meetings with key providers and provide regular feedback on the status of their queries - pro-active approach to the servicing needs of the key provider together with monthly reporting on analysis of enquiries/complaints received
- Building and maintaining relationships with clients and key personnel within the providers
- Conducting business reviews to ensure clients are satisfied with the Scheme and services
- Inform the key provider about changes within the Scheme
- Attending meetings with key providers to build relationships
- Achieving client relationship targets and KPI’s
- Carrying out key provider satisfaction surveys and reviews
- Monitoring business performance against service level and flagging potential issues
- Maintain and update key provider records and notify Management accordingly
- Liaising with internal departments to ensure key provider’s needs are fulfilled effectively

**Client Services**
- Manage a comprehensive client service function, ensuring timeous and accurate service delivery
- Provide authoritative expertise and advice to clients and stakeholders
- Deliver on agreed service agreements made with key providers and internal and external stakeholders in order to ensure that client expectations are managed
- Make recommendations to improve client service experience and fair treatment of clients - based on analysis (RCA/complaints/enquiries)
- Improv

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