Job Description

Company DescriptionAbout 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.The Outbound Relationship Specialist 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.KEY OUTCOMES (not limited to) Level 4 and 5 process elementsSkills 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 requirementsMust have experience in working with all provider types and understand the logic as to how providers administration systems work for claims to be submittedMust have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issuesKnowledge of The Protection of Personal Information Act (POPIA) and the ability to apply this in day-to-day functionsComputer literate - Intermediate MS Office a mustMIP System experienceScope of responsibility:Developing, maintaining, and managing stakeholder relationships in the private and public sectorWorking on multiple projectsCollaborating with key stakeholders and departments to ensure efficacyEnsuring that the healthcare provider network composition includes an appropriate distribution of providersMaintaining and enhancing healthcare provider networks while meeting and exceeding accessibility, quality, financial goals, and cost initiativesParticipating in cross-functional teams to develop new, enhanced systems processes, programs, and policies to support business needsInitiating and implementing action plans to increase quality and productivityDeveloping and managing relationships across the provider networks - including general practitioners, dental practitioners, pharmacies, radiologists, pathologistsReporting: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 youCollect data timeously for the compilation and completion of reports to Divisional Head Network and Risk executiveComplete quality audits monthly on all network related SOPsQualificationsSPECIAL REQUIREMENTSAbility to maintain confidentiality, problem solve, negotiate and communicatePERSON DETAILS: WORK EXPERIENCEREQUIREDWorks independently and with minimal supervisionAbility to make judgment calls and utilising proper discretion.Excellent oral and written communication skillsExcellent customer service and sound computer skillsAbility to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist.PREFERREDProven work experience as a client or provider Management roleA minimum of 6 years experience in the South African healthcare marketEDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODYREQUIREDMatricFAIS CompliantRE 5 and Class of BusinessValid Driving LicenseTECHNICAL SKILLS OR KNOWLEDGEREQUIREDComputer Literacy - Microsoft Excel, Word and PowerPointStrong phone, email (written) and inter-person communication skills.PREFERREDKnowledge of Medical Scheme IndustryMIP 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

Kaelo