GEMS Vacancies Cape Town – Provider Liaison Officers

Website Government Employees Medical Scheme - GEMS

Job Description:

The Provider Liaison Officers will report directly to the Senior Manager: Networks and Provider Relations and forms part of the Healthcare Management Division.

Job Responsibilities:

  • Perform a secretariat function for the provider relations engagements.
  • Provide substantiated commentary on the quality of network services and provider compliance to the Scheme network agreements.
  • Provide substantiated commentary on the quality of network services and provider compliance with Scheme network agreements.
  • Support the Senior Manager: Networks and Provider Relations in maintaining the GEMS relationship with healthcare providers within assigned region.
  • Fulfil various stakeholder engagements as directed by the Chief Healthcare Officer.
  • Participate in the review and submission of GEMS networks reports- Support the Senior Manager:
  • Networks and Provider Relations in the management of the Managed Care Organisations that are contracted by the Scheme.
  • Support other Scheme Division’s in managed care activities.
  • Participate in the review of the providers efficiency reports.
  • Provide periodic reports relating all stakeholder engagements to the Senior Manager: Networks and Provider Relations.
  • Represent the Healthcare Management Division at SPN and Stakeholder Engagements and promote network participation by healthcare providers.
  • Serve as a single point of contact for escalations related to claims and authorizations issues from the providers within the assigned region.
  • Ensure continuous education on GEMS strategy, systems, processes and product to the relevant providers within the assigned region.

Job Requirements:

  • At least 5 years work experience in the healthcare funding/medical scheme industry.
  • Be a self-starter.
  • Must have experience in provider relations management.
  • Excellent communication and writing skills.
  • Must have experience in the development and presentation of management reports- Computer literacy and MS Office skills.
  • Own transport essential.
  • Have ability to work well as part of a team.
  • Have sound planning/project management skills.
  • At least a 3 year Diploma/Degree or equivalent NQF level in Clinical Sciences related fields.
  • Have diligent work ethics with attention to detail.
  • Experience in case/ claims management will be advantageous.
  • Be responsible and reliable.
  • Sound Quantitative and qualitative analysis skills with ability to manage priorities.

Job Details:

Company: Government Employees Medical Scheme – GEMS

Vacancy Type: Full Time

Job Location: Pietermaritzburg

Application Deadline: N/A

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