Medical Scheme Senior Manager: Administration Services

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