Lets Write Africa's Story Together!

Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

Job Description

The incumbent will be responsible for ensuring adherence to, implementation of, and adoption of Compliance, Anti-Money Laundering (AML), and Sanctions-related policies, procedures, and process requirements within Old Mutual and its subsidiaries. This includes execution of customer due diligence processes, ensuring compliance with Know-Your-Customer (KYC) standards, conducting ongoing and enhanced due diligence, and maintaining data quality. Additionally, the role involves identifying and monitoring potential AML, Sanctions, or Compliance breaches and unusual activities, and escalating these concerns to the Risk and Compliance Office for further action.

To oversee the technical aspects of clinical operations in Health Business. This will cut across case management, claims processing, provider onboarding, and claims quality assurance.

PRINCIPAL ACCOUNTABILITIES

Claims Cost Management: Develop and implement internal and external strategies to address claims costs.Case Management: Oversee the case management process, ensuring efficient and effective handling of claims from initiation to resolution.Claims Processing: Develop and implement strategies to streamline claims processing, reducing turnaround times and improving accuracy.Provider Onboarding: Manage the onboarding and provider audit process for healthcare providers, ensuring they meet all necessary qualifications and are integrated smoothly into the network. Providing oversight on provider discount negotiations.Claims Quality Assurance: Implement quality assurance programs to monitor and improve the accuracy and consistency of claims processing.Data Analysis: Analyze claims and case management data to identify trends, areas for improvement, and opportunities for cost savings.Team Leadership: Lead and develop a team of clinical operations staff, providing training, support, and performance evaluations to  meet overall business strategic objectivesStakeholder Collaboration: Collaborate with internal and external stakeholders, including healthcare providers, regulatory bodies, and insurance partners, to ensure seamless operations and cost management.Strategic Planning: Develop and implement strategic plans to enhance clinical operations and achieve organizational goals.Automations: Deliver technology automations that will address operational gaps affecting clinical teams.

SKILLS/QUALIFICATIONS:

Bachelor's degree in Healthcare Administration, Nursing, or a related fieldMinimum of 5 years of experience in clinical operations, claims processing, or a related fieldRelevant certifications in healthcare management or clinical operations are preferredStrong leadership skills with the ability to inspire and motivate a teamExcellent analytical skills to interpret data and make informed decisions.Exceptional communication skills for effective collaboration and stakeholder management.Strong problem-solving abilities to address and resolve operational challenges.High attention to detail to ensure accuracy and compliance in all operations.In-depth knowledge of healthcare operations, claims processing, and regulatory requirements.

PERSONAL ATTRIBUTES 

Good communication skillsKnowledge of medical insuranceGood people skillsDiplomacy and tactHonesty and integrityGood assessment and analytical skillsAbility to work with cross functional teamsAbility to meet strict deadlinesAbility to interact at all levels

Skills

Action Planning, Backlog Management, Change Management, Data Compilation, Executing Plans, Legal Practices, Occupational Safety and Health, Oral Communications, Organizational Design, Policies & Procedures, Professional Presentation, Project Budget Management, Project Delivery Management, Readiness Assessments

Competencies

Builds Effective TeamsCommunicates EffectivelyCustomer FocusDirects WorkDrives EngagementDrives ResultsEnsures AccountabilityFinancial Acumen

Education

NQF Level 9 – Masters

Closing Date

20 May 2025 , 23:59

The Old Mutual Story!