Operations Manager: Benefit and Risk Management

A Managed Healthcare Company based in the North/West of Johannesburg, has a vacancy for an Operations Manager: Benefit and Risk Management.

The person will be providing benefit and risk management in the following specialties : Pre-Auth, Case Management, Medical Advisory, Pharmaceutical, Patient driven care and Claims management.
To monitor, identify, liaise, develop and implement clinical and management strategies to optimize the department and benefit allocation and administration.
Develop, main tin and monitor operational support tools, systems, reporting structures and protocols for work flows an quality assurance pertaining to daily operations.
Participate in organisational, departmental, policy, protocol and procedure analysis, review and development.

Requirements:
Matric
Tertiary qualification – clinical would be preferred
At least 3 years operations management experience in in a healthcare environment
Previous customer service experience will be essential
Thorough understanding of ICD-10, CPT and tariff coding
Sound knowledge and understanding of legislative frameworks pertaining to Medical Schemes and Managed Healthcare