Head of Medical Business

Job Closed!
Company:Britam
Category:Healthcare & Pharmaceutical
Job Type:Permanent
Location:Nairobi

Job details

Key responsibilities: Overall
  • 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.
Medical Underwriting
  • 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
Essential Competencies

 

 

 

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

 

 

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Healthcare & Pharmaceutical Britam 1 month ago
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