Let's Write Africa's Story Together!

Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

Job Description

Strategically manage and optimize Old Mutual’s medical service provider network by ensuring cost-effective contracting, high-quality healthcare delivery, and strong provider relationships, while driving clinical governance, operational efficiency, and an excellent customer experience for Old Mutual clients.

Key Outputs and Deliverables

• Manage provider contracting frameworks, including negotiated tariffs and reimbursement rates, annual tariff reviews, cost benchmarking against market rates, and the administration of capitation and fee-for-service (FFS) models.
• Build and sustain strong, strategic relationships with medical service providers through structured and ongoing engagements to enhance customer loyalty, service quality, and network performance.
• Design, implement, and continuously improve a quality assurance framework to ensure high standards of healthcare service delivery to Old Mutual clients.
• Gather, analyze, and interpret market intelligence on provider practices to inform pricing strategies, quality improvement initiatives, and operational decision-making.
• Negotiate, reconcile, and manage provider tariffs, including the development of medical and surgical packages to secure competitive and cost-effective pricing.
• Implement and manage a provider tiering framework to support cost control, member alignment, and consistent provider categorization across the business.
• Develop and execute a provider network expansion strategy, including the establishment of telemedicine and digital health partnerships to strengthen chronic disease management.
• Ensure timely follow-up on provider payments and remittances in line with agreed service level agreements (SLAs).
• Coordinate and deliver training programmes for service providers on Old Mutual’s service standards, claims guidelines, policies, and operational processes.
• Share provider remittance statements and payment advice accurately and within agreed timelines and resolve related provider queries promptly.
• Monitor and address customer service issues to ensure timely resolution and an enhanced customer experience.
• Promote and embed a customer-centric culture through leadership by example, particularly in engagements with medical service providers.
• Track and monitor medical claims settlement turnaround times (TATs) to ensure compliance with internal standards and contractual obligations.
• Develop, maintain, and apply provider quality assessment tools, clinical quality scorecards, and continuous provider improvement plans.

Skills

• Clinical Quality Management
• Healthcare Networks
• Operational Efficiency
• Provider Contracts
• Provider Relations
• Service Delivery

Competencies

• Directs Work
• Drives Results
• Ensures Accountability
• Manages Complexity
• Optimizes Work Processes
• Plans and Aligns
• Tech Savvy

Education

• Bachelors Degree (B): Medicine (Required)
• Bachelors Degree (B): Nursing (Required)
• Bachelors Degree (B): Public Health (Required)

• Manage provider contracting frameworks, including negotiated tariffs and reimbursement rates, annual tariff reviews, cost benchmarking against market rates, and the administration of capitation and fee-for-service (FFS) models.
• Build and sustain strong, strategic relationships with medical service providers through structured and ongoing engagements to enhance customer loyalty, service quality, and network performance.
• Design, implement, and continuously improve a quality assurance framework to ensure high standards of healthcare service delivery to Old Mutual clients.
• Gather, analyze, and interpret market intelligence on provider practices to inform pricing strategies, quality improvement initiatives, and operational decision-making.
• Negotiate, reconcile, and manage provider tariffs, including the development of medical and surgical packages to secure competitive and cost-effective pricing.
• Implement and manage a provider tiering framework to support cost control, member alignment, and consistent provider categorization across the business.
• Develop and execute a provider network expansion strategy, including the establishment of telemedicine and digital health partnerships to strengthen chronic disease management.
• Ensure timely follow-up on provider payments and remittances in line with agreed service level agreements (SLAs).
• Coordinate and deliver training programmes for service providers on Old Mutual’s service standards, claims guidelines, policies, and operational processes.
• Share provider remittance statements and payment advice accurately and within agreed timelines and resolve related provider queries promptly.
• Monitor and address customer service issues to ensure timely resolution and an enhanced customer experience.
• Promote and embed a customer-centric culture through leadership by example, particularly in engagements with medical service providers.
• Track and monitor medical claims settlement turnaround times (TATs) to ensure compliance with internal standards and contractual obligations.
• Develop, maintain, and apply provider quality assessment tools, clinical quality scorecards, and continuous provider improvement plans.

• Clinical Quality Management
• Healthcare Networks
• Operational Efficiency
• Provider Contracts
• Provider Relations
• Service Delivery

• Bachelors Degree (B): Medicine (Required)
• Bachelors Degree (B): Nursing (Required)
• Bachelors Degree (B): Public Health (Required)