Provider Relationship Officer: ZSIC Life Limited x5

ZSIC Life Limited is one of Zambia’s leading provider of life assurance products and
services. It is wholly owned by the Government of the Republic of Zambia through
the Industrial Development Corporation (IDC).

ZSIC Life under the project it is carrying out seeks to employ the following:-

PROVIDER RELATIONSHIP OFFICER X 5

Reports to: Provider Relationship Manager

JOB PURPOSE AND SCOPE

The main role of the jobholder is to ensure that a sound relationship is maintained between the Insurer and its provider Network, that all provider accreditation activities are carried as per insurer’s policy, ensure that all preauthorizations and case management issues are managed within prescribed guidelines and timelines as detailed in turn:-

i. Provider Accreditation;

• Review all applications for recruitment to the insurer’s provider network
• Ensure that all applications to the insurer’s provider network are inspected using the insurer’s inspection tool.
• Ensure that all accredited providers are trained on the insurer’s scheme rules, policies and processes

ii. Pre-authorisations /Case Management;

• Approves all pre-authorizations within the insurer’s policy rules;
• Maintains a pre-auth register;
• Manages all referrals and any other provider requests;
• Makes at least 3 member visitation for admitted cases every week and
• Prepares case management reports for any critical cases to be shared with management.

iii. Provider relationship Management;

• Be the face of the insurer to all health care provider forums
• Manage all communications between the insurer and its HCP network

Core Competences Required:

• Understanding of current and emerging issues relevant to the Health insurance industry
• Overall understanding of Health Care provider operations and medicine in general. This involves a specific understanding of medicines and treatment procedures.
• A refined understanding of the Zambian Legal and Regulatory framework surrounding Health Insurance and HCPs.
• A good understanding of the National Health Insurance Act and SI 63 that operationalizes the authority.
• Strong commercial acumen and operational experience
• Ability to work with limited supervision and make judgment calls
• Persuasive communicator (both written and verbal) with the ability to operate in and communicate at all levels in the organization.
• Influencing skills and using those skills to drive change and add value
• Strong execution skills to achieve the targets of INSURER in relation to health care provider management.
• Research and analysis skills
• Excellent Communication and reading comprehension

Qualifications, Experience, Knowledge & Skills;

• Minimum Diploma in Clinical Nursing, Clinical Medicine or any health-related qualification.
• An insurance qualification is an added advantage
• Good computer skills and competent user of Excel, PowerPoint and MS Office suite
• Ability to think clearly and assess matters quickly and to solve problems on short notice

Interested individuals who meet the specified requirements can send their
application letter and curriculum vitae ONLY to [email protected] before the close of
business on Friday 3rd April 2020. Kindly ensure that you indicate the position you are applying for in the subject line.

Note that only those who meet the above requirements will be considered.