SERVICE MANAGER: CLAIMS MANAGEMENT – Health Risk Management Botswana (HRMB)

Health Risk Management Botswana (HRMB) exists to offer a comprehensive range of fully outsourced quality solutions, including medical aid administration and health risk management. The company caters to medical aids as well as large corporate clients. HRMB is searching for enthusiastic and highly driven individuals that can provide outstanding service to take on the following position:

1. SERVICE MANAGER: CLAIMS MANAGEMENT

The successful candidate needs to ensure effective management of resources to achieve Service Levels, standards, and targets to ensure delivery of consistent superior customer experience. This position reports directly to the HOD: Claims Management

KEY RESPONSIBILITIES INCLUDE:

• Develop and maintain Claims Management as a fully-fledged business unit
• Ensure consistent and excellent application of set standards by monitoring staff performance levels, checking quality of work and recommending corrective steps
• Compile annual budget for group
• Route system related problems to relevant parties
• Generate, compile, and analyse productivity reports and statistics required as business information by the executive management
• Maintain any changes to the Claims systems, processes, and procedures
• Maintain quality processes in accordance with ISO 9001:2000 standards
• Monitor procedures/SOP’s regulating functions performed in the group
• Apply/monitor/maintain the National Reference Pricing List or Agreed Tariff List rules/amendments to rules and benefit structure per Scheme Plan on the Administration System annually
• Apply/monitor/maintain various quality controls on price code maintenance screen to prevent claims payments for services not allowed.

THE IDEAL CANDIDATE SHOULD:

• Have Degree/Diploma in Business or related field
• Between 5 – 8 years’ experience in a Claims environment
• At least 2 years’ experience as a team leader/supervisor in a Claims environment
• Knowledge of medical scheme rules
• Knowledge of National Health Reference Pricing List
• Excellent language skills
• Able to function independently as well as in a team
• High level of computer literacy: MS Office Package
• Well-developed leadership, organisational, interpersonal and communication skills