Service Provider Relations Officer

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.

• 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.

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

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

• Directs Work

• Drives Results

• Ensures Accountability

• Manages Complexity

• Optimizes Work Processes

• Plans and Aligns

• Tech Savvy