Operations and Retention Manager

2 weeks ago

Durban, KwaZulu-Natal, South Africa Total IT Recruitment Full time

Reputable company is looking for a Operations and Retention Bureau Manager who plays a pivotal role in leading and expanding the claims administration team within the business.

In this pivotal role, you will spearhead the claims administration department, working collaboratively with fellow line managers and the business line executive.

Your mandate is to champion the ongoing enhancement of operational efficiency, contributing significantly to the evolution of a more agile and streamlined Bureau.


Duties will includë:

  • Defining and executing the direction and vision for the claims administration department in accordance with the overarching strategy of the Bureau
  • Leading, hiring, mentoring, and inspiring the claims administration team to achieve operational excellence and contribute to the growth objectives of the business
  • Fostering a positive work environment emphasising collaboration, innovation, continuous improvement and accountability
  • Accountable for maintaining budgeted client churn levels by developing and executing strategies to both reduce churn and implement preventative measures.
  • Driving the digitization goals of the business to leverage the development and data teams by collaborating with the relevant stakeholders to drop the cents per rand billed per staff member.
  • Taking a proactive role in client communication, holding accountability for ensuring timely, quality, and effective resolution of conflicts.
  • Establish, refine, and evaluate measurable Key Result Areas (KRAs) for Claims administrators and the supervisor, aligning them with organisational objectives
  • Take ownership of the accountability process by implementing specific metrics (SOP's), conducting regular reviews, and assessing individual performance against these benchmarks. This approach ensures a datadriven strategy to drive continuous improvement, fostering optimization of team effectiveness
  • Implement clear and measurable communication metrics to assess the quality and timeliness of interactions with clients on all channels. This includes ensuring that reports sent to clients are adhered to the highest standards of quality and accuracy
  • Maintain client churn rates below budgeted figures, implementing proactive strategies to achieve and exceed set targets. Be accountable for accurate tracking and analysis of churn metrics, and actively address and resolve issues to ensure high levels of client satisfaction
  • Strategically lead the hiring process to build a dynamic and highperforming claims administration team, ensuring alignment with growth objectives. Identify and attract top talent, fostering a team that contributes significantly to the overarching goals of the business
  • Delivering and ensuring that the unique value proposition sold to a client is continuously met
  • Instilling a culture of embracing automation within the team and acting as the driving force behind the adoption of digitisation and automation
  • Working closely with the Tech team by fostering effective and clear communication and collaboration. Articulating and understanding the complex problems related to automation
  • Testing and validation of newly built automation as well as integrating newly built automation into existing workflows while minimising disruptions
  • Overseeing the billing and invoicing processes with the finance team while managing credit notes ensuring accurate financial transactions
  • Collaborating with the line managers and business line executive to deliver on the Bureau strategy

Qualifications & Experience
-
Tertiary education, preferably in an associated field (e.g. Business Administration, Healthcare Management, B.Comm or similar)
-
A minimum of 3 years experience in a similar medical administrative management role in a business-to-business (B2B) context

  • Brings a minimum of 5 years of extensive coding experience in the medical billing industry, showcasing a comprehensive understanding of coding practices and industry standards.
  • Recent handson experience in effectively managing and leading a team of more than 20 individuals, demonstrating strong leadership skills, fostering a positive team culture, and achieving organisational objectives
  • A proven track record of navigating and optimising financial processes within the healthcare industry, with a keen eye for detail and compliance with financial standards and regulations.
  • Proven collaboration with technology/software teams, clear problem articulation, and adeptness in testing and integrating software solutions and newvfeatures into existing workflows.

Knowledge and Skills

  • Possesses outstanding expertise in ICD10 coding and an excellent understanding of SAMA (South African Medical Association) and CMS (Centers for Medicare & Medicaid Services) rules
  • Possesses an excellent medical background, showcasing proficiency in medical terminology and a comprehensive understanding of human anatomy.
  • Full understanding of the processes, procedures, and s

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