Our client in the healthcare insurance space is looking for a Provider Network Consultant in the KZN area.


  • Develop integrated networks with quality providers yielding a geographically competitive, broadly accessible, stable network that achieves company objectives.
  • Evaluate practices in analysing member care, and trend quality compliance at the provider level.
  • Develop action plans and programs to support provider practices in continuous quality improvement using approved guidelines.
  • Responsible for provider education, contract compliance, and resolving provider concerns and issues
  • Negotiate all Provider Network, casualty, and Hospital contracts on an individual basis and or in groups
    (IPA’s and discipline-specific groups) where appropriate.
    Partner with internal stakeholders to create a seamless experience for providers.
  • Ensure all enquiries are resolved satisfactorily and customer requirements within business rules are met.
  • Continuous risk management of all providers and take action in areas where costs are exuberant.
  • Identify and resolve network access gaps or perceived gaps.
  • Supply monthly management reports.


  • Matric
  • FAIS Compliant
  • RE 5 and Class of Business
  • Valid Drivers Licence

Skills and Experience:

  • At least 2-5 years of experience in a similar role
  • Sound understanding of the South African Health industry, options, benefits, etc.
  • Ability to develop interpersonal business relationships with network providers and internal business partners leading to high provider and member satisfaction.
  • Meeting targets and regulatory requirements.
  • Must have experience in working with all provider types and understand the logic as to how providers’ administration systems work for claims to be submitted.
  • Must have a working knowledge of behavioural health provider business operations and analytical abilities to resolve provider issues.
  • Excellent oral and written communication skills
  • Computer literate – MS Office suite, i.e. Word and Excel a must.
  • A good understanding of claims risk profiling.
  • This position requires extensive travelling.
  • Ability to travel to all providers.

Desired Skills:

  • Healthcare insurance
  • MS Office

Desired Work Experience:

  • 2 to 5 years

About The Employer:

A leading healthcare insurance provider in South Africa

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