Claims Manager (Sizwe Medical Fund) Gauteng, Johannesburg Metro Johannesburg Metro, Gauteng (South Africa) Permanent|Permanent/Contract Management Level position in the Any Sector sector. Ref 1528705 | Posted 03 Jul 13 by Sizwe Medical Fund Sizwe is one of the biggest open medical schemes in the country with a strong heritage linked to the struggle against apartheid. It remains a strong brand with great potential to capitalize on the consolidation and the changes in the industry. An exciting opportunity exists for a position of a Claims Management Executive of the transforming fund which is based in Johannesburg. Areas of responsibility: • Support development of Fund strategy • Develop a strategy to manage clinical and financial risk of the Fund that is aligned to the overall strategy. • Conduct analysis of risk profile and the claims trends and develop effective interventions that will support the sustainability of the Fund. • Monitor the Fund administration operations and develop corrective measures where necessary. • Develop managed healthcare solutions for the Fund, and implement or monitor their implementation. • Monitor the quality of service to the members and the performance of providers to the relevant contracts. • On-going research to develop innovative strategies that improve access, clinical outcomes and cost of delivering healthcare to our members. • Manage the ex-gratia, complaints and member appeals. • Procure and negotiate contracts with relevant suppliers and manage their performance. • Take responsibility for tariff negotiations on behalf of the fund. • Interact with relevant stakeholders, communicate and represent the funds’ position in selected forums • Human resources management for the team that reports to the unit. Requirements: • Minimum of 5 years experience in medical funding and / or managed healthcare. • Healthcare qualification like B.Pharm,MBChB or similar, will be an advantage • Business management qualification is essential • Senior management experience • Computer literacy • Strategic thinking ,leadership ,negotiation and monitoring skills • Self starter and independence Please send CV’s to [email protected] . Closing date is 12 July 2013 Applicants who have not been contacted by us by 19 July 2013 can assume that their application has not been successful. People with disabilities are encouraged to apply.
Posted on: Wed, 10 Jul 2013 10:22:36 +0000
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