Manager: Masterfiles

2 weeks ago

Cape Town, South Africa Health Solutions Full time

**Introduction**
- Momentum Health, an entity of Momentum Metropolitan Holdings Limited, delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.**Role Purpose**
- The role is responsible for the management of all price files in the Business System Solution area including the management of:
- Scheme, Modifier and Network rates
- Maintenance of network providers
- Maintenance of relative value units (RVU)
- Maintenance of rand conversion factors (RCF)
- Escalated tariff related queries
- Reporting on tariff discipline related queries
- Maintenance of Provider Masterfile
- Claims reprocessing

**Requirements**:

- Matric
- Minimum of 3 - 5 years' experience in the claims operations environment is essential
- In depth understanding of reference price lists and industry standard pricing structure is essential
- Business or management degree or studying towards will be advantageous
- A clinical qualification or extensive clinical knowledge will be advantageous
- High level of proficiency in Healthcare and Medical Scheme administration landscape

**Duties & Responsibilities**

**Operational Management
- Managing the day-to-day operational functions by ensuring Momentum Health Solutions meets and exceeds SLA’s.
- Provide insights into what is driving transactional trends and provide innovative solutions to improving unnecessary volumes into Momentum Health Solutions environment.
- Actively pursue improvement in quality of back-office function processing.
- Oversee enquiry investigations and ensure that responses are comprehensive and well-constructed.
- Participate in regular operational and other forums as required by clients (All Momentum Health Solutions clients).
- Creating a positive working environment and optimise human capital outputs and quality.
- Management of Leave, overtime and productivity for team.
- Performance Management of team.
- Report on monthly / quarterly performance for the area under review as required by Scheme / Internal Stakeholders.
- Manage departmental budgets and employer asset base (hardware, software etc.)
- Ensure functional compliance with the Medical Scheme's Act.

**Audit Function**
- Ensure that functional area perfects audit findings and where these occur facilitate remediation within timelines agreed with internal/external auditors.

**Stakeholder Management
- Drive collaboration with internal stakeholders to ensure optimal value chain service delivery.
- Develop sound relationships with customer in order to foster trust and credibility.
- Attend industry platforms to ensure MH visibility.
- Ensure compliance with internal and external requirements.

**Competencies**
- Business Acumen
- Client / Stakeholder Commitment
- Drive for Results
- Leads Change and Innovation
- Motivating and Inspiring Team
- Strategic Thinking
- Collaboration
- Impact and Influence
- Self-Awareness and Insight
- Diversity and Inclusiveness
- Growing Talent

  • Junior Bookkeeper and Payroll Administrator

    4 weeks ago

    Cape Town, South Africa RJPersonnel Full time

    2years - Capture Creditors invoices weekly - Reconcile Creditors accounts to supplier statements monthly - Capture the Cashbook for Click N Hire Weekly - Capture Debtors invoices when necessary - Create recons or spreadsheets when necessary - Preparing weekly payments - Assist with Audit recons - Adhoc duties - Payroll System - Pastel Sage Payroll - Loading...

  • Accounts Payable Clerk

    2 weeks ago

    Cape Town, South Africa Epsidon Management & Marketing Consultancy Full time

    **JOB PROFILE**: **Job Title**:Accounts Payable Clerk **Division**:Finance - Accounts Payable **Location & Address**:Cape Town **Reports to**:Accounts Payable Manager **Direct Subordinates**:0 **Total Staff in Function**:4 **WORKING RELATIONSHIPS**: **Internal**: - Procurement - Sales Operations - Brand Operations - Account Managers - Systems...

  • Senior Bookkeeper

    3 weeks ago

    Cape Town, South Africa Zeal HR Full time

    An excellent opportunity has become available for a Senior Bookkeeper. The role is based in the Cape Town area. **Requirements**: - A Financial Accounting qualification or equivalent - 10 - 15 years' experience in Bookkeeping role - Experience > 2 accounting software packages - Demonstrated ability to manage multiple demands and meet deadlines. - Good...

  • Finance Administrator

    3 weeks ago

    Cape Town, South Africa Lion of Africa Life Assurance Company Full time

    **General** - Take responsibility for all performance related tasks as required by Management. - Take responsibility for the ongoing reporting of any irregularities to Management. - Comply with company’s HR Policies and Procedures & Code. - **Duties include, but not limited to**:_ - Maintenance of supplier invoices, bank statements, etc. - Supplier account...

  • Retail/wholesale Credit Controller

    1 week ago

    Cape Town, South Africa Rory Mackie & Associates Full time

    Reports to the Credit Manager **Requirements**: - Previous experience required working with the main national retail chain stores. - Time management and meeting deadlines. - Good Communication skills and problem-solving skills. - Must be able to work with difficult suppliers and resolve difficult issues with global suppliers. - Ability to work well under...

  • Fixed-term Development Administrator

    2 weeks ago

    Cape Town, South Africa ooba Full time

    ooba Home Loans has a new 6-months fixed-term opportunity for a results-focused and dutiful individual who pays exceptional attention to detail and provides a high-level administrative service. Based at ooba’s Head Office in Cape Town, the Development Administrator is a support role working closely with the Development Manager to ensure seamless execution...

  • Configuration Specialist X 5

    1 week ago

    Cape Town, South Africa Momentum Metropolitan Holdings Full time

    -Introduction Momentum Health Solutions (MHS), an entity of Momentum Metropolitan Holdings, delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes...

  • Junior Accountant

    4 days ago

    Cape Town, Western Cape, South Africa Taylored Appointments Full time

    JOB OBJECTIVE:To assist the finance team in maintaining and compiling financial reports and statements in compliance with legal requirements.RESPONSIBILITIES:Bi-weekly capturing of cash and credit card payments for all 3 companiesMonthly accounting and processing up to trial balanceCapturing and reconciliation of all bank accountsMonthly reconciliation of...

  • Accounts Payable Clerk

    2 weeks ago

    Cape Town, South Africa Epsidon Management & Marketing Consultancy Full time

    **Job Title**: Accounts Payable Clerk **Division**:Finance - Accounts Payable **Location & Address**:Cape Town **Reports to**:Accounts Payable Manager **Total Staff in Function**:4 **WORKING RELATIONSHIPS**: **Internal**: - Procurement - Sales Operations - Brand Operations - Account Managers - Systems Engineers / Presales - Marketing - Logistics -...

  • Payroll and HR Administrator

    2 weeks ago

    Cape Town, South Africa Baker Tilly Greenwoods Full time

    **BAKER TILLY GREENWOODS** **JOB DESCRIPTION: PAYROLL AND HUMAN RESOURCES ADMINISTRATOR** **Background on the Firm**: Baker Tilly Greenwoods is one of the oldest and largest independent auditing, accounting and advisory firms in Cape Town. As an independent member firm of Baker Tilly International, we operate within South Africa with associated independent...

  • Assistant Product Accountant

    2 days ago

    Cape Town, Western Cape, South Africa Old Mutual South Africa Full time

    Assistant Product Accountant page is loadedAssistant Product AccountantApply locations Pinelands posted on Posted Yesterday job requisition id JR-61386Let's Write Africa's Story TogetherOld Mutual is a firm believer in the African opportunity and our diverse talent reflects this.Job DescriptionThe Assistant Product Accountant role is required to assist the...