Head of Clinical Operations - Health at Old Mutual Kenya

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 objectives
• Stakeholder 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 field
• Minimum of 5 years of experience in clinical operations, claims processing, or a related field
• Relevant certifications in healthcare management or clinical operations are preferred
• Strong leadership skills with the ability to inspire and motivate a team
• Excellent 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 skills
• Knowledge of medical insurance
• Good people skills
• Diplomacy and tact
• Honesty and integrity
• Good assessment and analytical skills
• Ability to work with cross functional teams
• Ability to meet strict deadlines
• Ability to interact at all levels