Talent Pool: Clinical Team Leader MMH260907-4

Role Purpose

To provide leadership to clinical teams, ensuring they meet key performance indicators (KPIs) by understanding client needs, member health risk profiles, and improving claims outcomes, while advocating for clients and stakeholders to meet service objectives.

Requirements

• Matric
• Tertiary qualification in the field of health ( B Cur, MBCHB) (Essential)
• 3 - 5 years working experience in an managed care environment
• 2 years of experience in a client facing role would be advantageous
• Registration with relevant regulatory body determined by qualification (Essential)
• Knowledge of relevant industry legislation, trends and competitors
• Healthcare management, and managed care knowledge
• Understanding of medical scheme environment, rules and regulations would be advantageous

Duties and Responsibilities

PROCESS

• Plan and forecast resources, control budget, and ensure strategic, operational, and contractual obligations are met and accurately reported.
• Establish and monitor key performance areas (KPIs) for the teams, track performance, and implement strategies to drive continuous improvement and meet or exceed established targets.
• Identify opportunities to enhance claims outcomes through data analysis, process optimisation, and collaboration with internal stakeholders, resulting in improved efficiency, accuracy, and customer satisfaction.
• Develop and maintain relationships with key internal and external stakeholders and inspire collaboration within the team and wider business unit.
• Maintain professional communication and develop, update, and document business processes for human capital management service delivery in line with product design and customer-specific segment requirements.
• Take accountability for all audit and risk management requirements, provide clinical input and assistance, and train and upskill direct reports.

CLIENT

• Continuously monitor turnaround times and quality standards, manage client query processes, and provide regular reports on the delivery of services against agreed service level agreements and in terms of overall client targets.
• Provide authoritative expertise and advice to clients and stakeholders, build and maintain relationships, negotiate and deliver on service level agreements, and make recommendations to improve client service and fair treatment of clients within the area of responsibility.
• Understand client needs and member risk profiles to develop and deliver tailored healthcare solutions and services.

PEOPLE

• Create a positive work climate and culture to energise employees, demonstrate exemplary leadership behaviour, and select and recruit suitably qualified talent in line with employment equity principles.
• Drive a culture that guides and directs best practices, enables a learning and growth culture, executes effective workforce planning practices, identifies employee growth and development needs, manages performance, and encourages innovation, change agility, and collaboration within the team.

FINANCE

• Implement and compile budgets, control budgets, manage high-risk and problematic financial issues, plan and implement a cycle of medium-term improvements to drive the pricing of services and products, and implement and manage financial risk methodologies, techniques, and systems to monitor and report on financial activities.
• Ensure strategic, operational, and contractual obligations are met and accurately reported, including financial aspects, by planning and forecasting resources, controlling budget, and implementing financial risk methodologies, techniques, and systems to monitor and report on financial activities.
• Implement and provide feedback on the effectiveness of the financial policy, practice, and procedures, prevent illegal, unethical, or improper conduct, implement risk management, governance, and compliance policies, and investigate reported willful acts of non-compliance to organisational policy and practice, and report on findings.

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