Health Operations Manager

**Company Description**
Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change. Kaelo meets the Healthcare needs of Corporate and Retail clients across South Africa - products offerings include Medical Insurance, Medical Aid, Gap Insurance, Kaelo Money and employee assistance programmes.

The Health Operations Manager will oversee our company’s operational processes and ensure superb customer experience. They will optimize our organisation's operating capabilities and employ strategies to maximize customer satisfaction.

Ensure the company’s strategies and operations align with their established plans and policies
Work together with the senior executive team to develop and implement the corporate strategy
Ensure optimal implementation and performance of certain essential functions

Further develop and drive implementation of strategic objectives for the business and provide continuous thought-leadership

Present new ideas, models and innovative solutions to strategic stakeholders and regularly report on progress

Oversee daily operations and effectiveness of the business unit through the management team

Ensures effectiveness within the service operating, workforce planning and quality models

Provide leadership and guidance to direct reports across various levels within in the business unit

Ensure overall delivery and quality of the unit's offerings to its stakeholders

Generates annual budget, monitors and approves expenses and reports on variances to superiors and the Finance department

Assessing and implementing improved processes and new technologies and collaborating with management regarding the implementation of these improvements.

**Daily and Monthly Responsibilities**

Oversee company operations and employee productivity, building a highly inclusive culture ensuring team members thrive and organisational outcomes are met.

Driving the company’s operating capabilities to surpass customer satisfaction and retention, and company goals.

Oversee daily operations of the company and the work of managers in membership, servicing, claims and billing functions. These functions are responsible for:
**Membership**:

- Onboarding and Maintenance of Policy Holders, Clients and Intermediaries
- Profile and policy management
- Maintenance of all stakeholder details
- Manage Offboarding of Clients and associated stakeholders
- Manage suspensions, resignations and terminations

**Servicing and Executive Office**:

- Ensure high quality query resolution while maintaining Service Level Agreements, Quality and Customer Perception Metrics
- Management of all complaints and ensuring customer experience metrics are achieved and maintained

**Claims**:

- Ensure that claims are paid timeously and within Service Level Agreements
- Enhance and improve claims processes to ensure optimal client experience

**Billing**:

- Manage Billing Processes and Queries
- Prepare and Manage Billing Runs
- Manage Billing Reconciliations
- Manage Debt Outstanding
- Manage Intermediary Commissions
- Manage Premium Bordereaux

Monitor performance with tracking and establish corrective measures as needed, and prepare detailed reports, both current and forecasting
**Qualifications**

PERSON DETAILS: WORK EXPERIENCE

At least 5 years of experience in relevant operations and preferably the healthcare industry

7-10 years experience in leading teams and major projects (senior management)

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

Relevant degree or equivalent qualification

PREFERRED

Post Graduate or higher level qualification
**Additional Information**
**PERSONAL ATTRIBUTES : COMPETENCIES**
- Accountability
- Action orientated
- Communication
- Simple writing skills
- Manages Complexity
- Problem solving skills
- Effective and Effective Mind Set
- Business Astute
- Planning and organisation
- Resilient and adaptive
- Self-development
- Significance and values orientated

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