Specialist Network Provider Manager

Recruiter:

Fusion Personnel

Job Ref:

JHB005442/Maris

Date posted:

Wednesday, May 21, 2025

Location:

Johannesburg, South Africa

Salary:

900000 Annually

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

POSITION INFO:
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.

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