The position of two Specialist Provider Liaison Officers is vacant. The Specialist Provider Liaison Officers will report directly to the Manager: Healthcare Networks and Provider Relations and forms part of the Healthcare Management Division. The positions are based at Head Office in Pretoria.

The total remuneration package for these positions is negotiable based on qualifications and experience.

The Specialist Provider Liaison Office will be required to provide support to the Senior Manager: Networks and Provider Relations through the implementation of the following Key Performance Areas (KPAs):

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

Qualifications and other requirements are:

• At least a 3 year Diploma/Degree or equivalent NQF level 6 in Clinical Sciences related fields
• At least 5 years work experience in the healthcare funding/medical scheme industry
• Must have experience in provider relations management
• Experience in case/ claims management will be advantageous
• Must have experience in the development and presentation of management reports
• Computer literacy and MS Office skills
• Sound Quantitative and qualitative analysis skills with ability to manage priorities
• Have ability to work well as part of a team
• Be responsible and reliable
• Have diligent work ethics with attention to detail
• Excellent communication and writing skills
• Have sound planning/project management skills
•  Be a self-starter
• Own transport essential

All external candidates, please apply via Career Junction using the following link :

https://www.careerjunction.co.za/companies/35144/government-employees-medical-scheme

The closing date for applications is 10 July 2023. Should you not hear from us by 30 September 2023, please consider your application unsuccessful.

*** GEMS employs people with the highest level of integrity – submission to the appropriate pre-employment assessment is obligatory to be considered for the position.

*** Kindly note that the information provided on application of the position may be shared with a third party for vetting purposes and will be stored by GEMS for a period of 5 years.

*** Kindly note that information is required for Employment Equity Purposes and information gathered is strictly used according to the intended purpose of collection, unless there is a legal need or permission is granted from the applicant themselves to make use of it for other purpose

*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.

*** GEMS adopts a hybrid work model

***GEMS is guided by the principles of employment equity. Preference will be given to groups who are underrepresented in accordance with GEMS employment equity plan.