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Primary Healthcare Insurance: Medical Service

2 weeks ago


Durban, South Africa BQuad Solutions Full time

Duties & Responsibilities
- Development of integrated medical service provider networks within the KZN region identifying any access gaps
- Building relationships with various medical service providers through regular visits over an extensive area
- Meeting targets and regulatory requirements
- Development of action plans to support provider practices to ensure high quality services to members
- Provider education and evaluation of practices to ensure compliance to high levels of member care
- Contract compliance and resolving provider concerns/issues
- Negotiate contracts on an individual or group basis for provider network, casualty and hospital contracts
- Ensure a seamless provider experience within the organisation
- Handle all customer queries
- Take action regarding excessive costs charged by providers and continually assess and manage risk
- Monthly management reports

**Desired Experience & Qualification**:

- Matric and Commercial Diploma a minimum (FAIS compliant qualification or significant progress towards this)
- RE 5 and Class of Business
- Minimum 2 years experience in a similar role
- Health industry, insurance options and benefits knowledge
- Proven track record of meeting targets
- Understanding of medical providers claims administration systems and business operations in order to solve issues
- Claims risk profiling
- MS Office (Word and Excel) a MUST
- Extensive provincial travelling to all medical service providers within the network (on the road role not office based, though home office set up advantageous)

**Package & Remuneration**:
R35 000.00 CTC (including Medical Insurance and Provident Fund)