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Executive: Member Protection

3 months ago

Pretoria, Gauteng, South Africa DPT Recruitment Full time

Job Purpose


To lead the development and implementation of the Member Protection objectives and functions of the organisation to ensure that members and beneficiaries of medical schemes are protected, serviced, and enabled.

You will work within the organisation and report to the Chief Executive & Registrar.

Key Performance Areas

  • To lead and coordinate the development of the strategic plan, annual performance plan, and operational plans of the different Member Protection subdivisions to ensure statutory reporting within set deadlines
  • To ensure alignment of strategy and budget allocations on an ongoing basis
  • To manage, monitor, and take accountability for performance of Complaints Adjudication, Customer Care, Clinical Consulting Services, and Education & Training
  • To act as a professional advisor to the Council on all relevant matters on an ongoing basis
  • To develop, review and recommend changes to policies and implementation procedures for the approval to the relevant stakeholders as appropriate on an ongoing basis
  • To manage subordinates on an ongoing basis within key deadlines according to their KPAs and KPIs
  • To liaise with external stakeholders and to develop strategic relationships to inform organiational strategy on an ongoing basis within key deadlines
  • To build and maintain long term relationships with expert support panels to ensure improved quality of service to meet company objectives on an ongoing basis
  • To ensure the active engagement with stakeholders on issues affecting the medical schemes environment and our regulatory function through industry advisory committees on an ongoing basis
  • To ensure compliance with internal financial controls and the PFMA in the area under your control on an ongoing basis
  • To tie strategic objectives of the organisation to annual and mediumterm budget proposals
  • Oversee and account for the management of audit activities effectively across Member Protection division
  • Oversee and account for the effective and efficient budget management activities within the division
  • Oversee and account for the management of effective and efficient risk management activities
  • To ensure daily optimum utilisation and improvement of the Human, Information and Organisational capital in your functional area to improve the Organisations utilisation of its Human, Information and Organisational resources
  • To perform any additional responsibilities or tasks according to specifications as and when required

Requirements:

  • Masters degree qualification in Public Health or Legal or Business Management
  • A minimum of 15 years overall experience, of which 5 years must be in a Senior Management role; 5 years in Complaints Management and 5 years in Private or Public health services
  • Sound knowledge of strategy and policy formulation
  • Knowledge of SAQA frameworks and Consumer Act/ Rights
  • SAs healthcare financing and delivery system, product knowledge and pricing
  • Knowledge of Medical Schemes Act and Healthcare environment
  • Knowledge of ethics and corporate governance
  • Knowledge of business risks and mitigation strategies
  • Knowledge of all related legislation impacting and influencing the functioning of the organisation (MSA, PFMA, BBBEEA, LRA, EEA etc.)
  • People management, financial and project management skills
  • Excellent communication skills, complaints resolution skills
  • Attention to detail, analytical skills, and ability to handle pressure
  • Ability to motivate and influence others
  • Computer literacy