Location: Centurion, Gauteng

Position Purpose: As a PLO, you will be the face of the organisation to healthcare providers, building strong relationships, resolving operational issues, supporting digital enablement, and ensuring providers understand and comply with network requirements. Your work directly strengthens provider satisfaction, improves member experience, and enhances the effectiveness of our provider network.

Minimum Requirements

• Degree or Diploma in Health Sciences, postgrad in Healthcare Management, Business Management, or related field will be advantageous
• 2–4 years of experience in provider relations, managed care, medical scheme administration, or healthcare operations.
• Experience engaging with healthcare providers (GPs, specialists, allied, hospitals).
• Understanding of PMBs, clinical coding (ICD‑10, CPT), and benefit rules (advantageous).

Key Responsibilities:

Provider Engagement & Relationship Building:

• Manage day‑to‑day interactions with GPs, specialists, hospitals, allied providers, and pharmacies.
• Conduct provider visits, virtual meetings, and education sessions on benefit rules, DSPs, and clinical protocols.
• Build and maintain strong, professional relationships across your allocated provider base.

Issue Resolution & Operational Support:

• Resolve queries related to authorisations, claims, billing, benefit rules, and clinical processes.
• Work closely with internal teams (clinical risk, customer service, benefits, medicines management) to resolve provider issues.
• Track escalations and ensure timeous resolution.

 Provider Communication & Training:

• Educate providers on network participation requirements and managed care protocols.
• Communicate system updates, benefit changes, and digital process enhancements.
• Support onboarding and orientation of new providers onto the network.

Digital Enablement:

• Promote use of digital tools, including provider portals, e‑authorisation, and e‑contracting.
• Assist providers with troubleshooting and adoption of digital systems.
• Gather feedback to support ongoing improvement of digital platforms.

Monitoring & Reporting:

 Monitor provider behaviour related to DSP compliance, utilisation, and quality indicators.

• Document all provider interactions, risks, and trends.
• Prepare monthly activity reports and insights for management.

Compliance & Governance

• Ensure all provider engagements align with CMS, PMB, POPIA, and organisational requirements.
• Maintain accurate and audit‑ready documentation.
• Identify non‑compliance issues and escalate appropriately.

Competencies: 

• Excellent communication and interpersonal skills.
• Strong problem‑solving and conflict‑resolution abilities.
• Ability to interpret provider and claims information.
• High attention to detail and accuracy.
• Strong digital literacy (MS Office, provider portals, clinical systems).
• Ability to work independently and in teams.

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