General Manager: Claims

Responsibilities:

• Claims management
• To monitor, identify, liaise as required, develop and implement management strategies to optimise the department ,ensure accurate benefit allocation and administration
• Develop, maintain and monitor operational support tools, systems, reporting structures and protocols for work flows and quality assurance pertaining to daily operations;
• Participate in organisational, departmental, policy, protocol and procedure analysis, review and development
• To ensure operations remain within Scheme rules and policies, protocols and procedures
• To ensure all Company quality standards are enforced and maintained by staff
• To manage high level queries and requests and direct to senior management where necessary
• Compile and present monthly management reports to senior management
• Support staff in the performance of their duties
• Develop and maintain educational, training and workforce development programmes and departmental goals and provide coaching for staff on processes and products;
• Responsible for direct supervision, training, performance evaluations, recruitment, disciplinary actions and termination of staff;
• Ensure effective communication channels within the department, inter-departmentally and externally as required
• Be a positive role model for all staff, providing effective leadership and acting as a change agent when required
• Lead, develop and foster team and corporate culture
• Maintain professionalism and confidentiality
• Undertake duties as required to ensure effective daily operations;
• Perform any related duties as required

Minimum requirements:

• Tertiary Qualification
• 3 years operations management experience in a healthcare environment essential
• At least 3-4 years exposure at management level
• Experience of managing an operational team in pressured environment
• Previous customer service experience essential
• Excellent writing skills (e-mail/ letter writing etiquette)
• Excellent time keeping and willing and able to put in extra time
• Excellent attendance record

• Emotional maturity, self-driven, flexible, ability to cope with pressure
• Good customer centricity, interpersonal skills, written and oral communication, negotiation, conflict resolution, team building and diplomacy skills
• Sound knowledge and understanding of legislative frameworks pertaining to Medical Schemes Analytical and proactive characteristics
• Thorough understanding of ICD-10, CPT and tariff coding
• Well developed IT skills, participated in IT system development/implementation
• Good attention to quality and accuracy
• Bi-lingual advantageous

Take note that this is a guideline of what the company expects of you but not limited to the tasks mentioned

PLEASE DO NOT APPLY IF YOU DO NOT MEET THE CRITERIA