Medical Scheme Senior Operations Manager

2 weeks ago

Pretoria, Gauteng, South Africa Careforce Recruitment Full time
Our client, a managed care organisation in Pretoria are currently looking for a

Senior Manager:
Operations.

Thisis an equal opportunity oganisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.
Reporting to:
Dual reporting role to both Chief Executive Officer and General Manager

Location:
Head Office Pretoria (on-site)

Contract Type:
Fixed Term Contract for period of 12 months (with possibility of becoming permanent thereafter)

Salary:
Subject to experience market related CTC package that includes medical scheme and provident fund

Purpose of the position


To provide leadership and manage various operational teams to ensure the achievement and maintenance of service levels across all functional areas of service delivery.

The successful incumbent must be able to translate the business strategy into the business operations through the effective use and implementation of best practices principles; setting and achieving company objectives and individual staff goals; and the analyses and interpretation of various operational processes and workflow metrics to continuously and pro-actively ensure service delivery improvement.


Summary of Responsibilities and Duties:

  • Ability to implement business objectives and strategies
  • Daily monitoring of team targets/duties/performance
  • Identify, prioritise and proactively allocate resources to the operational need
  • Be the conduit for daily operational communication
  • Participate in developing performance plans, set goals and objectives
  • Ensure a balanced allocation of supporting resources
  • Manage expenditure in terms of overtime work against performance targets
  • Liaise with relevant stakeholders to gather information and to effectively attend to and resolve operational needs
  • Ensure all relevant communications and data are updated and recorded
  • Set performance targets for speed, operational efficiency, accuracy and quality in service delivery to maintain contracted service levels.
  • Establish and measure success in meeting goals, objectives and service level adherence
  • Review the performance of staff, identify training needs and plan knowledge transfer and training sessions in collaboration with the HR department
  • Record statistics, user rates and the performance levels of various teams as well as individual staff members
  • Undertake needs assessments, performance reviews and cost/benefit analyses
  • Prepare reports on the statistics, rates and performance levels
  • Presentation of reports to Rx Group Executive Management as well as other key stakeholders, such as contracted medical scheme clients
  • Personally attend to the most complex customer complaints or enquiries and provide timely and accurate feedback. Where required, involve other key stakeholders or Executive Managers
  • Interpret, communicate and ensure implementation of all company policies, procedures and, where relevant, client schemes' clinical protocols and funding guidelines.
  • Maintain uptodate knowledge of industry developments
  • Mentor, coach, motivate and retain staff
  • Coordinate staff recruitment and liaise with HR department

Qualifications and experience

  • Bachelor's degree in business administration or similar
  • Minimum 10years' experience within the services industry, of which at least 5 years should be in a leadership/ management role.
  • Relevant legal and statutory knowledge i.e. BCEA, Medical Scheme's Act, POPIA, LRA etc.
  • Knowledge of medical scheme services including but not limited to provider claims payment, preauthorisation processes and Council for Medical Scheme's complaints resolution will be advantageous.
  • Experience in process reengineering to achieve improved service levels and client satisfaction ratings, making critical decisions and exploiting opportunities for efficient operations.
  • Experience in all aspects of Industrial Relations.
  • Demonstrated ability to foster a teamorientated and interconnected work environment.
  • Valid driver's license.

Other Skills and Competencies

  • Critical reasoning and decisionmaking skills
  • Ability to manage high levels of pressure, demands and emotionally charged situations and to make sound decisions
  • Excellent communicator and people skills
  • A handson approach
  • Foster teamwork
  • Proficient with MS Office (Power Point, Excel, Word, Outlook)
  • Excellent verbal and written communication skills in English
  • High degree of accuracy and attention to detail
  • Administration and reporting skills

  • Senior Manager: Corporate Communication

    2 weeks ago

    Pretoria, Gauteng, South Africa Medihelp Medical Scheme Full time

    About the role: Medihelp has a key opportunity for a Senior Manager Corporate Communication, reporting to the Head Marketing, to develop and implement communication strategies targeting the Scheme's various stakeholders.Essential functions of the job:Formulate strategies and ensure that a supporting budget is compiled, approved and managed effectively. ?...

  • Senior Manager: Managed Care

    2 weeks ago

    Pretoria, Gauteng, South Africa Medihelp Medical Scheme Full time

    Responsible for the overall management of the Medicine and Healthcare (pre-auth, case management and hospital audit) divisions through the following actions:Ensure all registered Medihelp benefits are clinically defined and that protocols and algorithms are uploaded to the system;Develop clinically defined protocols and algorithms for pharmaceutical...

  • Senior Manager: Innovation

    2 weeks ago

    Pretoria, Gauteng, South Africa Medihelp Medical Scheme Full time

    Responsible for the benefit and protocol framework through the following actions:Define a benefit and protocol framework and indicate short- and long term business priorities; andFormulate and implement a plan to shift the focus on Medihelp's benefit allocation from curative to preventative.Implement the provider network strategy through the following...

  • Senior Manager: Alternative Product Offerings

    2 weeks ago

    Pretoria, Gauteng, South Africa Medihelp Medical Scheme Full time

    Responsible for the development of innovative, competitive and marketable alternative benefit offerings through the following actions:Develop loyalty and reward programmes for Medihelp to grow Medihelp's market share;Develop a platform to understand and measure loyalty drivers;Act as champion to facilitate the realization of alternative product offerings,...

  • Product Training Facilitator

    2 weeks ago

    Pretoria, Gauteng, South Africa Medihelp Medical Scheme Full time

    Determine needs for specific training areas from advisors as well as internal personnel.Compile presentation and conduct training sessions.Make sure that BDC's are up to date with all changes that can have an effect on new business.Give Medihelp product presentations to potential groups.Keep training manual updated.Make sure that accreditation test on the...

  • Gems Careers – Human Resources Administrator

    2 weeks ago

    Pretoria, Gauteng, South Africa Government Employees Medical Scheme - Gems Full time

    Job Description:The position of HR Administrator is vacant.The HR Administrator will report directly to the Senior Manager: HR Operations and forms part of the Corporate Services Division. The position is based in Head Office.(ads1)Job Responsibilities:Governance, administration and reporting on HR matters.HR Administration and Support to the HR Team.Assist...

  • Executive: Operations

    2 weeks ago

    Pretoria, Gauteng, South Africa MCR – Medical and Management Corporate Recruiting Full time

    Minimum Requirements:***- Medical Degree and Business Qualification at NQF level 9***: - 10 years' experience in running Operations.***: - Experience within a Medical Scheme environment will be an added advantage.***: - A proven track record of leading large-scale Operations function***: - Physician Relationship Management and Clinical Risk Management***Role...

  • Medical Advisor

    2 weeks ago

    Pretoria, Gauteng, South Africa Stafflink Recruitment Solutions Full time

    About the role:Medical company has a key opportunity for a medical adviser, reporting to the Head: Operations, to contribute to the effective management of clinical risk and the cost-effective and appropriate utilisation of scheme benefits.Qualifications and experience:An MB Ch.B. degree and registered with the HPCSA, as well as at least 8 years relevant...

  • Executive: Strategy, Policy, and Regulatory

    2 weeks ago

    Pretoria, Gauteng, South Africa MCR – Medical and Management Corporate Recruiting Full time

    Requirements:***- A legal qualification***: - NQF Level 9 Postgraduate qualification in Business Administration/Legal/ Compliance***: - A minimum of 15 years' overall experience, of which 8 years must be in a Senior Management role;***: - 5 years in policy development and 5 years in private health services***: - 10 years' experience in Senior Management in...

  • Manager: Content

    2 weeks ago

    Pretoria, Gauteng, South Africa Medihelp Medical Scheme Full time

    We need a talented and experienced copywriter, public relations and communication specialist to join our Marketing team using different types of platforms and managing a team to generate relevant content for various stakeholders:Responsible for content management through the following actions:Delivery of quality, original content for the various...

  • Senior Manager

    2 weeks ago

    Pretoria, Gauteng, South Africa Tych Business Solutions Full time

    Job ID: 53663Date Posted: Posted 1 week agoLocation: PretoriaJob Title: SENIOR MANAGER - CLINICAL RISK MANAGEMENT - PERSONS WITH DISABILITIES - PRETORIADuties: Manage, set up and drive the Clinical Risk and Medicine Benefits management programme internally and externally (SPNs). Manage service providers to ensure Disease Risk Management (DRM) programmes are...

  • Senior Manager: Corporate Communication

    2 weeks ago

    Pretoria, Gauteng, South Africa Stafflink Recruitment Solutions Full time

    About the role:Company has a key opportunity for a Senior Manager Corporate Communication, reporting to the Head Marketing, to develop and implement communication strategies targeting the Schemes various stakeholders.Qualification and Experience:A National Diploma/Bachelors degree in marketing, Communication, Public Relations, or Journalism or equivalent is...

  • Hod- Data Scientist Reporting Specialist

    2 weeks ago

    Pretoria, Gauteng, South Africa Medical Placements Full time

    Tertiary Qualification (clinical, statistics, actuarial)- Data Science Qualification: Leadership Skills Reporting skills Medical Schemes Industry/legislation and regulations knowledge. Experience in a Claims Management environment is essential.

  • Operations Manager

    2 weeks ago

    Pretoria, Gauteng, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for an Operations Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Position: Operations ManagerReporting to: Life Business ExecutiveGrade: D5Hours: 8 Hours per day, 40 hours...

  • Call Centre Agent

    2 weeks ago

    Pretoria, Gauteng, South Africa Careforce Medical Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for a Call Centre Agent. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Position:Medical Call Centre Agent Adding or removing of dependants Processing medical scheme membership...

  • Senior Manager: Clinical Consulting Services

    2 weeks ago

    Pretoria, Gauteng, South Africa Future Africa Consulting (Pty)Ltd Full time

    The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolioto ensure medical scheme members are protected and their entitlements are guaranteed, and to develop and implement the Prescribed Minimum Benefits regulation strategyAs a Senior Manager:Clinical Consulting Services you will be...

  • Operations Manager

    2 weeks ago

    Pretoria, Gauteng, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for an Operations Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Position: Operations ManagerReporting to: Life Business ExecutiveGrade: D5Hours: 8 Hours per day, 40 hours...

  • Operations Manager

    2 weeks ago

    Pretoria, Gauteng, South Africa care force Full time

    Our client, a managed care organisation based in Pretoria is looking for an Operations Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Position:Operations ManagerReporting to: Life Business ExecutiveGrade: D5Hours: 8 Hours per day, 40 hours per...

  • Medical Call Centre Agent

    2 weeks ago

    Pretoria, Gauteng, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for a Call Centre Agent. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Position: Medical Call Centre AgentReporting to: Operations ManagerHours: 40 hours per week (Based on a shift...

  • Medical Call Centre Agent

    2 weeks ago

    Pretoria, Gauteng, South Africa Careforce Recruitment Full time

    Our client, a managed care organisation based in Pretoria is looking for a Call Centre Agent. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.Position: Medical Call Centre AgentReporting to: Operations ManagerHours: 40 hours per week (Based on a shift...