About the position
Provider Relations Manager
Are you an experienced healthcare insurance professional passionate about building and managing strong provider relationships? Our client, a healthcare insurance company, is looking for a dedicated Provider Relations Manager to join a team in Johannesburg North.
In this key role, you'll be the vital link between the company, its healthcare providers, and members, ensuring seamless service and effective network utilization.
Responsibilities
- Develop, manage, and maintain the national provider network, ensuring optimal access, cost-efficiency, and quality of care for members.
- Establish and monitor appropriate provider distribution to meet network adequacy standards across geographic and demographic segments.
- Lead the development and execution of provider contracting strategies, including new provider acquisition, ongoing relationship management, and renewals.
- Conduct regular provider visits to strengthen relationships, monitor service quality, and drive ongoing provider education and engagement.
- Ensure consistent adherence to agreed service levels and quality metrics by providers.
- Develop and implement Standard Operating Procedures (SOPs) for the setup, management, and review of provider agreements daily operations.
- Ensure accuracy and integrity of provider network data across all systems, enabling accurate administration and reporting.
- Design, negotiate, and manage provider fee structures in line with business strategies and market conditions.
- Monitor utilisation patterns, identify trends, and collaborate with internal teams to address inefficiencies and cost drivers.
- Lead and participate in interdepartmental projects to enhance systems, workflows, and overall network performance.
- Manage escalated provider or member issues where network involvement is required.
- Drive team performance through coaching, regular feedback and performance reviews (KPAs).
- Provide input into budget planning, cost management, and the strategic direction of the provider networks function. This includes ensuring efficient use of travel budgets through careful route planning, managing accommodation and daily allowances, and maximising provider coverage per visit to ensure cost-effective network engagement.
- Prepare reports and presentations for internal and external stakeholders, including executive-level reporting.
- Ensure the healthcare provider network includes a well-balanced mix of providers across relevant areas.
Qualifications:
- Commercial Degree/Diploma
- FAIS Compliant (Qualification, RE 5 and class of business a must)
- Valid driver’s licence
Skills and Experience:
- Minimum of 6 years’ experience in the South African healthcare market, with at least 3 years in a similar role involving healthcare provider network development and management.
- Proven track record in the negotiation, contracting, and management of healthcare providers across multiple disciplines: GPs, dental practitioners, pharmacies, radiologists, pathologists, optometrists, emergency services, hospitals (private and public), and out-patient casualty units.
- Demonstrate experience managing provider network utilisation.
- Strong leadership experience, with the ability to manage, mentor, and develop a team of consultants.
- Ability to work independently and exercise sound judgment and discretion in a complex and dynamic environment.
- Excellent verbal and written communication skills, with the ability to communicate at all levels, including with medical professionals and executive stakeholders.
- Highly proficient in Microsoft Office and other relevant business systems; ability to interpret and act on data.
- Ability to work under pressure, prioritise effectively, and maintain professionalism at all times.
- Have a proactive approach, take ownership, strong problem-solving ability, and a commitment to team collaboration.
Desired Skills:
- Healthcare insurance
- Relationship management
- Provider Network
- Key Account
