Medical Scheme Senior Manager: Administration
3 weeks ago
**Duties and Responsibilities**
**Administration service excellence**
- Develops the client’s administration strategy and manages its implementation
- Contributes to specifications for outsourced administration services to drive delivery of effective and efficient member enrolment, member records, contributions billing and collection, membership management, claims processing and adjudication, provider payments; reimbursements and membership termination
- Reviews and signs-off administrator business processes for delivery of the client’s member transaction administration as part of SLA conclusion process
- Develops KPIs and targets for administrator contract and establishes monthly review mechanisms
- Monitors delivery against SLA and manages deviations for effective contract management and cost effective and efficient administration
- Monitors implementation and adherence to Scheme rules in the client’s administration processes
- Identifies and seeks opportunities to maximise savings opportunities on claims whilst ensuring members are not compromised
- Develops and implements annual enrolment plans for new recruits, including facilitation of baseline health risk profiling
**Member debt and credit management**
- Monitors contributions and claims processes and addresses deviations with administrator
- Develops membership debt management strategies and monitor implementation in line with policy
- Develops member credit processes and monitor implementation
- Monitors implementation and adherence to Scheme rules by the Administrator
- Member query resolution
- Monitors and manages trends related to queries, complaints and issues raised by members to enable root-cause analysis and resolution
- Addresses escalated queries related to claims and contributions to enhance member delight
- Oversees query management process
**Third-party recoveries**
- Manages development and delivery of third-party claims strategies to minimise cost of claims to the scheme
- Ensures effective IOD and RAF recoveries through inhouse and outsourced processes;
- Senior Manager: Administration Services
- Monitor performance and report regularly to Executive on the overall progress and results against Operational Plan and initiate courses of action for improvement; and
- Ensure adherence and compliance to reporting requirements, including timelines, templates and frameworks.
**Strategic Management**
- Contribute to the development of the Operations Departmental operational plan, flowing from the client’s strategy;
- Cascade the Operations Departmental operational plan to Administration for line of sight and alignment;
- Monitor performance and report regularly to Executive on the overall progress and results against Operational Plan and initiate courses of action for improvement; and
- Ensure adherence and compliance to reporting requirements, including timelines, templates and frameworks.
**Stakeholder Management**
- Communicate the vision and objectives of the client’s Administration strategy to internal and external stakeholders;
- Forges beneficial relationships with SAPS at various levels to facilitate member experience excellence and health outcome improvement
- Lobby executive support and buy-in for relevant Administration initiatives;
- Ensure the effective integration between Administration and Member Experience and Engagement as well as the Marketing Unit;
- Manage relationships with Administration outsource partners and facilitate beneficial relationships;
- Champion in leading implementation of new Administration initiatives; and
- Provide regular feedback on progress and highlight or escalate snags and problems immediately as they occur.
**People Management**
- Build a positive staff and team culture and a climate that attracts, retains and motivates staff;
- Manage staff under supervision and conduct performance and talent management activities for direct reports;
- Coach and mentor direct reports;
- Oversee effective utilization of systems and tools to ensure that knowledge is managed efficiently for continuous improvement; and
- Recognise and make recommendations for the reward of high performing members; respects, promotes and accepts diversity.
**Financial Management**
- Responsible for development and administration of the functional area’s budget;
- Ensure adherence to approved budget;
- Manage and monitor budget through managing variances in actual vs. budget expenditure in all areas of accountability; and
- Develop and implement measures to improve the functional area’s cost management.
**Compliance and Governance**
- Executes in adherence to all relevant regulatory and business practices;
- Execute all Internal Audit exceptions and ensure the implementation of preventative measures in the unit; and
- Drive the resolution management of the identified top 5 Internal Audit risks.
**Culture**:Live and exemplify the client’s values
**Skills and Competencies**
- Effective people management
- Mentori
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