Provider Liaison Officer

Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses.

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Build, maintain and manage relationships with GEMS Stakeholders, network providers aligned to business objectives.

Qualification

• Matric Certificate
• Business related qualification (Essential)

Knowledge

• Knowledge of the network provider landscape
• Knowledge of relationship management principles

Experience

• At least 1-2 years provider relations industry experience / in a similar role
• At least 5 years work experience in the healthcare funding/medical scheme industry
• Must have experience in provider relations / client services management
• Experience in case / claims management (preferred)
• Medical claims processing experience
• Experience in the development and presentation of management reports
• Experience in the Health Care industry

Internal Process

• To efficiently manage and co-ordinate existing and potential relationships between Scheme, Stakeholders (Bureaus, Societies, Associations, Service Providers), SPNs and MH.
• To provide accurate and efficient service to Scheme and Stakeholders.
• Act as key contact to Service providers, Bureaus, Societies and the Scheme ensuring continuous communication and resolution of queries.
• Represent the business at forums, committees and stakeholder engagements.
• Ensure continuous education on the business systems, processes and product to the relevant providers.
• Serve as a single point of contact for escalations related to claims and authorizations issues from the providers.
• To identify enhancements to the service delivery and administration, and to promote these enhancements to the MH Management Team and Service Providers.
• To identify trends emanating from RCA that could assist with training and coaching of internal/external stakeholders.
• Participate/collaborate with various stakeholders in the provider engagement environment.
• Focus on continuous improvement of service delivery to providers and in turn the members’
• Build and maintain effective business relationships with all stakeholders.

Client Services

• Investigate client queries within the agreed service level and ensure that client receives timeous feedback and escalate client queries to the relevant department or stakeholder.
• Provide accurate information and advice to clients and stakeholders in order to ensure that the client receives the appropriate services.
• Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets.
• Proactively build and maintain client relationships.
• Deliver on service level agreements and made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service experience for internal and external stakeholders.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

People

• Develop and maintain productive and collaborative working relationships with peers , clients and stakeholders.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas.
• Take ownership for driving career development.
• Effectively manage time and ensure optimal productivity.
• Ensure technical product and legislative knowledge is always current in order to propose the most relevant and innovative client solutions and comply with governance requirements.
• Be self-confident, self-motivated and relentlessly pursue targets and goals.

Finance

• Identify solutions to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.
• Prepare, interpret and present performance reports and other relevant information so to enhance client understanding and facilitate decision-making.