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 with REF: Senior Manager
Closing date: 25 March 2022
