Networks Outbound Manager

1 month ago

Johannesburg, South Africa Kaelo Full time

Company Description
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:
Sound understanding of the South African Health industry, options, benefits, etc.
Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.
Meeting targets and regulatory requirements
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
Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues
Knowledge of The Protection of Personal Information Act (POPIA) and the ability to apply this in day-to-day functions
Computer literate – Intermediate MS Office a must
MIP System experience
Scope of responsibility:
Developing, maintaining, and managing stakeholder relationships in the private and public sector
Working on multiple projects
Collaborating with key stakeholders and departments to ensure efficacy
Ensuring that the healthcare provider network composition includes an appropriate distribution of providers
Maintaining and enhancing healthcare provider networks while meeting and exceeding accessibility, quality, financial goals, and cost initiatives
Participating in cross-functional teams to develop new, enhanced systems processes, programs, and policies to support business needs
Initiating and implementing action plans to increase quality and productivity
Developing and managing relationships across the provider networks – including general practitioners, dental practitioners, pharmacies, radiologists, pathologists
Reporting:
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
Collect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executive
Complete quality audits monthly on all network related SOP’s

Qualifications
SPECIAL REQUIREMENTS
Ability to maintain confidentiality, problem solve, negotiate and communicate
PERSON DETAILS: WORK EXPERIENCE
REQUIRED
Works independently and with minimal supervision
Ability to make judgment calls and utilising proper discretion.
Excellent oral and written communication skills
Excellent customer service and sound computer skills
Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.
PREFERRED
Proven work experience as a client or provider Management role
A minimum of 6 years’ experience in the South African healthcare market
EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED
Matric
FAIS Compliant
RE 5 and Class of Business
Valid Driving License
TECHNICAL SKILLS OR KNOWLEDGE
REQUIRED
Computer Literacy – Microsoft Excel, Word and Power Point
Strong phone, email (written) and inter-person communication skills.
PREFERRED
Knowledge of Medical Scheme Industry
MIP and Putty knowledge would be an advantage.

Additional Information

-
Accountability
- Action orientated
- Collaborative
- Communication
- Business writing skills
- Manage complexity
- Problem solving skills
- Decision thinking
- Encourages engagement
- Resilient and adaptive
- Resourceful
- Demonstrates self-awareness
- Purpose driven
- Significance and values orientated

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