Permanent
Gauteng, Pretoria
Posted 2 months ago

Together with our client in Pretoria, we are recruiting for a Senior Manager: Administration Services. The Ideal Candidate needs to have at least 8 years of experience in Administration Services in a medical scheme environment with 6 years of management experience. The Candidate needs to present an NQF Level 8 Postgraduate qualification in Business Management / Business Administration / Commerce.

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;
  • Active risk management by applying and promoting a culture of ongoing detection and resolution of Statutory, Regulatory Compliance breaches;
  • 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
  • Mentoring and coaching
  • Organisational skills (planning, budgeting, work-prioritization, time-management, etc)
  • Results and performance-driven
  • Business Acumen
  • Financial and Project Management skills
  • Business Report Writing, communication, and presentation skills
  • Interpersonal skills
  • Governance skills
  • Analytical skills, Research, problem-solving
  • Impact
  • Complex problem-solving skills (potential conflicting priorities)
  • Diplomatic (creating win-win solutions)
  • Decision making
  • Sound judgment
  • Awareness of sensitivities of different stakeholders
  • Prioritising of multiple tasks
  • Delegation
  • Knowledge of Corporate Governance legislation and frameworks including the Companies Act and King lV
  • Ability to work well in a multi-cultural environment
  • Collaborative skills

Required Minimum Qualifications

  • NQF Level 8 Postgraduate qualification in Business Management / Business Administration / Commerce
  • 8 years’ experience in Administration Services in medical schemes
  • 6 years management experience
  • Demonstrate deep knowledge of medical scheme administration

Salary:             Market Related

Benefits:         Medical Aid, Provident and Pension Fund

Only candidates who meet all the requirements stipulated in this advert, will be considered. If you don’t receive feedback from us within 2 weeks of your application, please consider your application as unsuccessful.

To apply please send your CV and supporting documents to recruitment1@qetello.co.za with REF: Senior Manager

Closing date:  25 March 2022

Job Features

Job CategoryAdmin, Management

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