Specialist Network Provider Manager

Fusion Personnel; South Africa; On-site; ZAR 300,000 - 450,000; Full time

Job summary

A well-established company in Johannesburg North is seeking a Specialist Network Provider Manager to enhance their provider network. The role involves managing contracts, ensuring compliance with healthcare regulations, and providing support to network providers. Ideal candidates will have a relevant diploma or degree, along with strong interpersonal and analytical skills.

Qualifications

• 1–2 years of relevant experience, preferably in healthcare or insurance.
• Knowledge of healthcare regulations, claims processing, and contracting.

Responsibilities

• Build, negotiate, and maintain a network of medical specialists.
• Oversee claims processes to ensure compliance with agreed terms.
• Track provider performance and key metrics.

Skills

Interpersonal skills

Negotiation skills

Communication skills

Analytical skills

Organizational skills

Detail-oriented

Education

Diploma or Degree (NQF Level 5 or higher)

Tools

MS Office

Job description

Well-established company based in Johannesburg North seeks a Specialist Network Provider Manager to join their team!

Requirements:

• Diploma or Degree (NQF Level 5 or higher)
• 1–2 years of relevant experience, preferably in healthcare or insurance
• Strong interpersonal, negotiation, and communication skills
• Knowledge of healthcare regulations, claims processing, and contracting
• Analytical, organized, detail-oriented, and able to manage multiple tasks
• Proficient in MS Office and basic computer applications

Responsibilities:

• Provider Network Management: Build, negotiate, and maintain a network of medical specialists. Handle contracts, rate negotiations, and provider communications.
• Strategy & Analysis: Identify gaps in provider networks and implement strategies to enhance efficiency and coverage. Monitor return on investment of network initiatives.
• Claims & Risk Management: Oversee claims processes to ensure compliance with agreed terms. Resolve provider disputes and discrepancies.
• Performance Monitoring: Track provider performance and key metrics. Report outcomes and recommend improvements.
• Compliance & Quality Assurance: Ensure providers follow relevant regulations and quality standards. Conduct audits and stay updated on industry regulations.
• Customer Service & Support: Act as a main contact point for providers, addressing queries and concerns professionally.
• Training & Development: Educate network providers on procedures, standards, and updates.

Desired Skills:

• Healthcare Provider Network Specialist
• Medical Network Manager
• Provider Relations Specialist
• Managed Care Network Coordinator
• Healthcare Network Contract Specialist