Qualifications, Skills and Experience Required:
Person Specifications: For appointment to this grade, an Officer must have:
- Cumulative service period of nine (9) years’ relevant work experience, three (3) of which should have been at the grade of Senior Benefits Management Officer 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.
- Certificate in Management courses lasting for at least four (4) weeks from a recognized institution.
- Proficiency in Computer applications.
- Shown merit and ability as reflected in work performance and results.
Responsibilities:
The Social Health Authority (SHA) is seeking a Principal Benefits Management Officer. This role involves comprehensive planning, implementation, and analysis of health benefit packages, ensuring their sustainability, affordability, and integrity through strategic purchasing and stakeholder collaboration.
Job Purpose: The role of an actuary is to provide independent advice on the financial risks facing an insurer; and determine profitability and sustainability of coverage of policies. The primary responsibility is to assess and manage the financial risks associated with reinsurance contracts and portfolios.
Officers in this cadre may be deployed to functional areas: -
- County Coordination
- Benefits Management.
Key Duties and Responsibilities:
- Undertaking operational planning for Health Benefits management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments.
- Implementing policies and strategies for effective and efficient Health Benefits management in collaboration with other departments.
- Implementing 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.
- Collaborating with the health Benefits Package & Tariffs Advisory Panel in evidence-based designing, reviewing, and updating of Benefit packages and Tariffs.
- Implementing 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 cost-effectiveness, affordability, budget impact of health benefit offerings and recommend optimizations to maintain sustainability.
- Collaborating with the Benefit Package & Tariffs Advisory Panel, to ensure the benefits packages and tariffs design, review and implementation processes are transparent and inclusive through stakeholder engagement.
- Support the effective implementation and continuous improvement of 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.
- Preparing reports on Benefits Management.
- Implementing robust internal controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders.
- Analysing the cost-effectiveness of benefit offerings and recommending optimizations to maintain sustainability.
- Supporting effective collaboration with external stakeholders to ensure transparency and trust.
- 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
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