Benefits Management Officer I - 4 Posts at The Social Health Authority (SHA)

Qualifications, Skills and Experience Required:

For appointment to this grade, a candidate must have: 

• Cumulative service period of three (3) years’ work experience at the grade of Benefits Management Officer II or in a comparable position; 
• Bachelor’s degree in any of the following disciplines: Pharmacy, Health Financing, Health Economics, Actuarial Sciences, Statistics, Nursing, Mathematics, Dentistry, or its equivalent from a recognized institution; 
• Membership with a relevant professional body, where applicable and in good standing; 
• Proficiency in computer applications; and 
• Shown merit and ability as reflected in work performance and results.

Responsibilities:

You will assist in implementing the operational plan for Health Benefits management, including risk assessments, strategic purchasing of benefit packages, and analysis of cost-effectiveness.

Key Responsibilities

• Implementing operational plan for Health Benefits management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments. 
• Implementing of policies and strategies for effective and efficient Health Benefits management in collaboration with other departments. 
• Participating in the strategic purchasing of prescribed benefit packages in close collaboration with the Directorate of Fund Management and other departments ensuring efficiency, equity, and cost-effectiveness in service delivery. 
• Carrying out collaborations with the health Benefits Package & Tariffs Advisory Panel in evidence-based designing, reviewing, and updating of Benefit packages and Tariffs. 
• Implementing the prescribed Benefits packages and Tariffs under the Primary Healthcare Fund for level 2, 3 and select 4 providers and facilities; under the Social Health Insurance Fund in level 4, 5 and 6 providers and facilities and the Emergency, Chronic and Critical Illness Fund in level 2-6 facilities and providers. 
• Analysing the cost-effectiveness, affordability, budget impact of health benefit offerings and recommend optimizations to maintain sustainability. 
• Collaborating with the Benefit Package & Tariffs Advisory Panel, ensure the benefits packages and tariffs design, review and implementation processes are transparent and inclusive through stakeholder engagement. 
• Implementing and improving Benefits and Tariffs management information systems, ensuring they support efficient operations and member satisfaction. 
• Collecting and analysing data for purposes of claim management in collaboration with other departments. 
• Analysing data for reports on Benefits Management Analyse the cost-effectiveness of benefit offerings and recommend optimizations to maintain sustainability. 
• Supporting effective collaboration with external stakeholders to ensure transparency and trust. 
• Implementing robust internal controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders. 
• Ensuring compliance with local and international standards in Benefits Management (as prescribed in the Act), fostering alignment with globally recognized best practices and enhancing the Authority’s reputation. 
• Implementing policies and strategies for business process re-engineering, driving innovation and efficiency in Benefits Management. 
• Providing expert guidance in Benefits management on reviewing and amending the Social Health Insurance Act, ensuring responsiveness to the evolving healthcare landscape and adherence to quality standards.