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GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS) VACANCIES
GOVERNMENT EMPLOYEES MEDICAL SCHEME (GEMS)
PROVIDER LIAISON OFFICER
Type: Permanent | Salary: The total remuneration package will be based on qualifications and experience.
Closing date: 18 October
Apply
The position of Provider Liaison Officer is vacant. The Provider Liaison Officer will report directly to the Manager: Provider Liaison Office and forms part of the Healthcare Management Division. The position is based at Head Office in Pretoria.
The total remuneration package for this position is negotiable based on qualifications and experience.
The Provider Liaison Officer will be required to provide support to the Manager: Provider Liaison Office 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 18 October 2022. Should you not hear from us by 31 December 2022 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.
*** Information is required for Employment Equity purposes.
*** 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.
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
***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.
PROVIDER LIAISON OFFICER
Type: Permanent | Salary: The total remuneration package will be based on qualifications and experience.
Closing date: 18 October
Apply
The position of Provider Liaison Officer is vacant. The Provider Liaison Officer will report directly to the Manager: Provider Liaison Office and forms part of the Healthcare Management Division. The position is based at Head Office in Pretoria.
The total remuneration package for this position is negotiable based on qualifications and experience.
The Provider Liaison Officer will be required to provide support to the Manager: Provider Liaison Office 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 18 October 2022. Should you not hear from us by 31 December 2022 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.
*** Information is required for Employment Equity purposes.
*** 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.
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
***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.
OPERATIONS MANAGER- ADMINISTRATION AND TRANSACTIONS SERVICES
Type: Permanent | Salary: The total remuneration package will be based on qualifications and experience.
Closing date: 17 October
Apply
The position of Operations Manager: Administration and Transactions Services is vacant. The Operations Manager: Administration and Transactions Services will report directly to the Senior Manager: Administration and Transactions Services and forms part of the Administration and Transaction Services Division. The position is based at Head Office in Pretoria.
The total remuneration package for this position is negotiable based on qualifications and experience.
The Operations Manager: Administration and Transactions Services will be required to provide support to the Senior Manager: Administration and Transactions Services through the implementation of the following Key Performance Areas (KPAs):
- Review, monitor, analyse and evaluate the operations performed by members of GEMS Service Provider Network (SPN)
- Supporting all operational reviews with accurate qualitative and quantitative analyses
- Review and report on weekly, monthly, and quarterly SPN reports (including special projects)
- Develop and produce scheduled monthly and quarterly operational reports (Global operations report, risk assessment and mitigation reports)
- Assess operations and recommend performance improvements
- Identify operational trends by effectively utilizing the Business Intelligence tools available to the Scheme
- Produce formal reports on all monitoring and evaluation interventions, inclusive of operational recommendations
- Ensure SPN compliance to approved operational mandates, policies, and procedures
- Conduct ongoing reviews of the Scheme’s business processes and recommend efficiency enhancements
- Effectively co-ordinate, record and manage queries and requests to and from the SPN
- Ensure that members of the SPN have appropriate business operational plans in place and that these are regularly tested
- Chair the monthly service provider performance meetings
- Ensure the timeous implementation of the SPN operational plans with efficient testing for operational efficiency
- Review and provide recommendation on SPN invoices
- Manage and report on day-to-day performance of service providers to ensure SLAs are tested and maintained including the review as and when necessary necessary
- Review, monitor, analyse and evaluate the performance of operational service providers
- Evaluate operational performance and contractual requirements against the Scheme’s business imperatives, mission, vision, and strategic objectives
- Identify, assess, monitor, and report all material operational inefficiencies
- Proactively recommend timeous guidance to the Senior Manager: Administration and Transaction on where there are operational performance gaps and provide related mitigations
- Develop operational intervention and outcomes against identified operational service failures
Qualification requirements are:
- Relevant financial/operational degree or equivalent NQF Level 6
- Minimum of 5 years’ experience in Operations or business analysis environment, with 3 years management level experience.
- Proficient in MS Office
- Proficiency in project management tools advantageous
- Experience in the medical scheme industry advantageous
- Excellent verbal and written communication skills
- Good project management and organizational skills
- Knowledge of the South African medical scheme industry
- Must be in possession of a valid driver’s license and own vehicle and be willing to travel at short notice
- Excellent service provider performance management monitoring
- The ability to actively maintain executive relationships with service providers and the industry
- Analytical and logical
- Self-starter who is able to work independently Solid experience in planning engagements, managing operations and project plementation;
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 17 October 2022. Should you not hear from us by 31 December 2022 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.
*** Information is required for Employment Equity purposes.
*** 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.
*** Should you wish to have your information removed from the GEMS database, kindly send a request in writing to jobs@gems.gov.za.
***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.