Specialist Provider Networks

Position Purpose:We are looking for a detail oriented and analytical Specialist: Healthcare Provider Networks to support the optimisation, performance monitoring, and day to day coordination of our healthcare provider network. In this role, you will work closely with hospitals, specialists, GPs, allied providers, and pharmacies to strengthen operational effectiveness, support contracting workflows, analyse provider performance, and enhance provider engagement. You'll also play a key role in digital enablement, compliance monitoring, and network data accuracy.

If you're passionate about bridging operational excellence with strong relationships and data driven insights, this role is for you.

Degree or Diploma in Health Sciences, postgrad in Business, or related field will be advantageous

• 3-5 years of experience in healthcare provider networks, managed care, medical schemes, or clinical operations.
• Familiarity with PMBs, coding (ICD 10, CPT, NAPPI), benefit rules, and reimbursement models.
• Experience working with hospitals, specialists, GPs, and allied health providers.
• Strong experience in data analysis and reporting (Excel/BI tools).

Network Operations & Support:

• Implement provider onboarding, updates, mapping, and network changes.
• Maintain accurate provider data across internal systems and member facing platforms.
• Conduct network adequacy assessments and support expansion initiatives.

Provider Engagement:

• Serve as a trusted liaison for hospitals, specialists, GPs, and allied providers.
• Support providers with queries on benefit rules, DSP arrangements, and protocols.
• Conduct provider visits, virtual engagements, and training sessions.

Contracting Administration:

• Prepare contract schedules, performance data, and negotiation support documents.
• Manage e contracting workflows, documentation tracking, and version control.
• Communicate contracting changes and ensure understanding of provider obligations.

Digital Enablement:

• Support providers in adopting digital solutions such as e authorisation, portals, and dashboards.
• Troubleshoot system issues and collaborate with digital/IT teams.
• Monitor and improve digital uptake.

Performance Monitoring & Analytics:

• Analyse provider claims, utilisation trends, quality indicators, and leakage.
• Produce dashboards and performance reports for decision making.
• Identify risks, anomalies, and opportunities for cost containment.

Compliance and Governance:

• Ensure adherence to CMS regulations, PMBs, POPIA, and internal governance.
• Maintain audit ready documentation and accurate records.
• Escalate risks, non compliance trends, and provider related issues
• Strong analytical and problem solving abilities.
• Excellent communication and relationship management skills.
• Ability to interpret claims and provider performance data.
• High attention to detail and documentation accuracy.
• Digital literacy and ability to adopt new systems quickly.
• Ability to work independently and collaboratively.

Note: Company reserves the right to close the advert before specified closing date.

PHA has its head office in Westville, KwaZulu-Natal. It operates country wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.