Job Description

Job Summary Minimum requirements:

• A bachelor's degree or diploma in a relevant field such as Administration, Business Management, Quality Management, or a related discipline.
• Minimum of 3-5 years of experience in quality assurance, process improvement, or a related field. Direct experience in the medical aid industry is highly desirable
• Knowledge of Legislation relating to the work of medical schemes:

• Scheme Rules
• Basic medical terminology and medical procedures and operations
• Internal systems and processes within CAMAF
• Prescribed Minimum Benefits
• Chronic Diseases List
• Benefit options
• South African Medical Association
• Managed Healthcare
• Preferred Provider Network etc.

Responsibilities:

• Responsible for overseeing and improving the quality and efficiency of managed care operations
• Analysing current processes, developing strategies for improvement, and ensuring compliance with industry standards
• Work closely with various departments to implement best practices and enhance service delivery
• Monitor and evaluate the effectiveness of current processes and identify areas for improvement
• Conduct regular assessments to ensure compliance with industry standards and regulations
• Analyse existing workflows and processes to identify inefficiencies
• Design and implement process improvements to streamline operations and improve service delivery and outcomes
• Collaborate with cross-functional teams to ensure seamless integration of new processes
• Prepare comprehensive reports for team leaders and management, highlighting key findings and recommendations
• Utilize data to drive decision-making and strategic planning
• Provide training and support to staff on quality improvement initiatives and new processes
• Develop educational materials and plan workshops to promote best practices
• Foster a culture of continuous improvement and excellence within Managed care
• Address and resolve any issues or concerns related to managed care quality and processes
• Monitor member and provider satisfaction levels

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