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To proactively serve in an advisory capacity and be the main point of contact for our clients on all matters pertaining to health risk management and wellness solutions. Provide support and guidance based on client needs and member health risk profiles. Implement key initiatives to improve claims outcomes and reduce risk. Be the strategic interface between key clients, solution design and health risk management execution capabilities for the purpose of client-centric solution discovery, service management, risk management and relationship management. This position reports to the CEO.
Duties & Responsibilities
Key Performance Areas:
Stakeholder Management
- Build and maintain relationships with clients and internal and external stakeholders.
- Understand the client's workplace programmes, health risk issues and competitor activity as it relates to health and wellness solutions.
- Understand other relationships that the client has with external stakeholders in the healthcare industry.
- Have a clear understanding of the client’s strategy and be able to advise clients relevant to their strategy on how PHA can effectively partner with the clients to realise their health and wellness objectives.
- Provide authoritative expertise and advice to clients and stakeholders. (Strong clinical support requirement.)
- Contribute to the process of negotiating objective and realistic service level agreements, monitor appropriateness and recommend adjustments.
- Drive client service delivery goal achievement in line with predefined standards to ensure that clients receive appropriate advice, service and that client expectations are managed.
- Present regular reports on delivery of services against agreed service level agreements and in terms of overall client targets.
- Provide executive summaries and forthcoming solutions in a concise and impactful manner.
- Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to make recommendations to improve client service and appropriate treatment of clients within area of responsibility.
- Contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
- Support and work closely with the Actuarial and Health Risk Management Teams, to provide clinical and research insight as it relates to emerging trends both locally and internationally.
- Cooperating and assisting the operations and reporting teams to identify reporting gaps and suggest opportunities for improvement based on client feedback and emerging trends.
- Support the communication of the value of managed care services and any healthcare or wellness solution..
Operational Leadership and Team Management
- Create a positive work climate and culture to give meaning to work, minimise work disruption and maximise employee productivity.
- Drive a culture that guides and directs best practice, fostering an environment of continuous learning, improvement and cohesiveness.
- Demonstrate exemplary leadership behaviour, through personal involvement, commitment and dedication in support of organisational values.
- Enable a learning and growth culture whereby information regarding successes, issues, trends and ideas are actively shared between team members.
- Encourage innovation, change agility and collaboration within the team.
- Manage expenses and costs and identify cost saving opportunities to support the department in achieving its financial goals and targets
- Contribute to the process of negotiating contract terms, tariffs and renewals.
- Manage high risk and problematic financial issues in area of accountability and contribute to the development of policy.
Competency Requirements:
Attributes
- Strong leadership and team management skills
- Excellent analytical and problem-solving abilities
- Exceptional communication and interpersonal skills
- Good organisational and administrative skills
- Ability to meet tight deadlines
- Strong relationship management skills
- Ownership: Make critical decisions based on what's right for PHA - Owning operational decisions
- Credibility: Lead with integrity and trust others as you would like to be trusted
- Entrepreneurship: Take chances to continuously improve our customer’s experiences -Driving operational efficiencies
- Influence: Engage with Customers and colleagues to advance the organisation's welfare
- Collaboration: Build work-related networks and share knowledge with colleagues
Knowledge
- Sound knowledge of the Medical Schemes Industry
- Excellent clinical knowledge
- Knowledge and application of relevant legislation
- Knowledge and application of processes and procedures
Skills
- Excellent computer technology skills
- Excellent business writing and reporting skills
- Attention to accuracy and detail
- Problem solving
- Numerical ability
Desired Experience & Qualification
Experience:
5 to 8 years working experience in a managed care environment in a senior operational, managerial, or strategic capacity. HIV management experience will be highly beneficial.
Qualifications
Bachelor’s degree in health(MBCHB/ B Pharm/BCur) preferred registration with HPCSA or SANC
Package & Remuneration
Market related cost to company package
Pension
Medical Aid
Performance Bonus
- Medical, Health & Social Care
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