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Quality and Process Specialist

3 months ago

Johannesburg, South Africa Fusion Personnel Full time
Minimum requirements:
  • A bachelor's degree or diploma in a relevant field such as Administration, Business Management, Quality Management, or a related discipline.
  • Minimum of 3-5 years of experience in quality assurance, process improvement, or a related field. Direct experience in the medical aid industry is highly desirable
  • Knowledge of Legislation relating to the work of medical schemes:
    • Scheme Rules
    • Basic medical terminology and medical procedures and operations
    • Internal systems and processes within CAMAF
    • Prescribed Minimum Benefits
    • Chronic Diseases List
    • Benefit options
    • South African Medical Association
    • Managed Healthcare
    • Preferred Provider Network etc.
Responsibilities:
  • Responsible for overseeing and improving the quality and efficiency of managed care operations
  • Analysing current processes, developing strategies for improvement, and ensuring compliance with industry standards
  • Work closely with various departments to implement best practices and enhance service delivery
  • Monitor and evaluate the effectiveness of current processes and identify areas for improvement
  • Conduct regular assessments to ensure compliance with industry standards and regulations
  • Analyse existing workflows and processes to identify inefficiencies
  • Design and implement process improvements to streamline operations and improve service delivery and outcomes
  • Collaborate with cross-functional teams to ensure seamless integration of new processes
  • Prepare comprehensive reports for team leaders and management, highlighting key findings and recommendations
  • Utilize data to drive decision-making and strategic planning
  • Provide training and support to staff on quality improvement initiatives and new processes
  • Develop educational materials and plan workshops to promote best practices
  • Foster a culture of continuous improvement and excellence within Managed care
  • Address and resolve any issues or concerns related to managed care quality and processes
  • Monitor member and provider satisfaction levels