Manage staff and resources, provide direction, set goals and ensure that overall department goals are attained.
Ensure profitability and loss ratio targets are meet
Manage relationships with clients, intermediaries and service providers to ensure agreed service level agreements are achieved and goodwill with all stakeholders is maintained.
Provide in-put and guidance during the review of the medical re-insurance treaty.
Support the Product Development team by identifying the consumer needs and developing required products and enhancements.
Ensures proper partner, scheme and member records are maintained in line with Britam’s Data Governance Policy
Supervision, appraisal, training and development of staff in the department.
Preparation of management reports.
Ensuring effective use of the Company’s medical IT systems including AIMS, INSIS, Image Now and SMART.
Leases with Centralized Operations and 3rd Service Providers to ensure smooth running of outsourced Medical Business Operations including monitoring adherence to service level agreements.
Gathers statistical information as directed/requested participates in internal and external audits; assists with the development and implementation of corrective action plans.
Implement the underwriting strategy and philosophy, policies and procedures
Prepare/maintain underwriting guidelines and ensure that the risks accepted in the company are within the set guidelines
Provide underwriting support for renewals and quotes
Vet all risks to ensure that only quality business is accepted at acceptable rates to ensure profitability and achievement of set loss ratio targets.
Review of pricing and scheme performance annually
Standardization of underwriting processes and monitoring of TATs to ensure delivery of high level customer service to enhance customer satisfaction and achieve set customer retention ratio targets.
Ensure compliance with credit control policies by enforcing cash and carry, ensure timely invoicing of clients and that the organization is not unduly exposed to credit risk.
Ensure compliance to Risk, regulatory and Internal audit requirements
Medical Claims Process
Approval of Medical claims within their authority matrix
Management of Medical services pre-authorization process
Implement claims policies, processes and procedures
Monitors case management team, activities, records and approvals.
Review of fund management and utilization reports
Review of provider service level agreements
Identifies areas of improvement for both our business and our clients and coordinates feedback to clients on risk management improvement areas, including facilitation of health talks
Negotiates with service providers to optimize our costs
Key Performance Standards and Areas
Compliance to underwriting guidelines and Cash and Carry Policy.
Achievement of profitability targets.
Achievement of loss ratio targets
Achievement of retention ratio targets.
Satisfied internal and external customers
A highly skilled, empowered and engaged workforce
Knowledge, experience and qualifications required
Knowledge, Qualifications and Experience
Bachelors of Commerce degree.
Professional qualification in Insurance (ACII or FLMI or AIIK)
Eight (8) years medical insurance experience with at least three (4) years in supervisory level
Dynamic, mature and self-driven leader
Mentor and coach manager who will deliver results
Deciding and Initiating Action: Ensures, key organisational objectives are met, takes responsibility for decisions, actions, projects and people while focussing on achievement of strategic results; takes initiative and works under own direction; initiates and generates activity; makes quick, clear decisions with limited information available which may include tough choices or considered risks; decisions and actions takes into account possible impact on all parts of the business.
Leading and Supervising: Provides the business with a clear direction based on the overall strategic intent of the organisation; motivates and empowers others with a clear sense of purpose; creates a positive organisational climate that fosters learning and development; acknowledge high potential talent; sets and articulates the vision and values through own personal behaviour.
Relating and Networking: Easily establishes, as well as assists others in building good relationships with customers and staff across all departments, inside and outside of the organisation; relates well to people at all levels; facilitates the resolutions of conflict and manages disagreements with tact and diplomacy.
Persuading and Influencing: Gains clear agreement and commitment from others by persuading, convincing and negotiating to the benefit of the organisation, promote the organisational strategy during conversations; makes effective use of political processes to influence and persuade others; promotes ideas on behalf of oneself, the department or the organisation; makes a strong personal impact on others; takes care to manage the organisation’s impression and brand on others.
Formulating Strategies and Concepts: Works strategically to realise organisational goals; sets and develops organisational strategies; identifies, develops positive and compelling visions of the organisation’s future potential; takes account of a wide range of issues across, and related to, the organisation; encourage others to take a strategic and long term view in terms of the organisation’s future; communicates the organisational strategy, vision and objectives effectively across all levels of the organisation.