Job title: Head of Regional Health Operations
Job type: Permanent
Emp type: Full-time
Industry: Insurance
Salary type: Monthly
Salary: negotiable
Job published: 2019-10-31
Job ID: 31040
Contact name: Hunters International
Contact email: Vincere@hunters-in.com

Job Description

Position

:

Head of Regional Health Operations

Industry

:

Insurance

Location

:

PJ

Remuneration

Reporting to

:

:

Up to RM 40,000

CEO, MY & Regional CEO

 

 

Responsibilities

  • To adhere to the departmental protocols set forth by the Head of BU in achieving the company objectives.
  • To ensure that all designated functions are executed precisely within the context of the company policies and the department strategic policies.
  • To ensure that all complaints directed or related to the functions of the department are handled and attended to in a timely fashion.
  • To ensure that all reporting staff executed functions are supervised consistently to ensure that the operations of the department are in compliance with the designated Service Level Agreement (SLA) between the company and its clients.
  • To ensure that all reporting staff executed functions are mentored effectively to ensure that the operations of the department are in compliance with the departmental protocols.
  • To ensure that the permissible level of efficiency is attained consistently.
  • To ensure that all reporting staff executed functions are managed effectively to ensure all departmental resources are utilized efficiently.
  • To ensure that the operations of the department remain sufficient and intact throughout its designated time of operations.
  • To ensure that all internal enquiries within the members of the department are attended to within the context of the company’s policies.
  • To observe and identify both the level of efficiency and competency of each and every member of the department through independent and quality judgement.
  • To continually assess the performance of the department and its members and contribute to the modification of the processes involved in the delivery of services.
  • To ensure that all members within the department are updated and well aware of both the current strategic policies and the company’s policies.
  • To ensure a close working relationship with all interdepartmental Heads and members. • To plan, establish and implement SOPs, workflows, best practices, ISO policies and ensure compliance with policies. This shall include compliance of legislative requirement such as data protection and medical confidentiality.
  • To monitor, review, enhance and/ or maintain quality service by enforcing quality and customer service standards. To analyse, plan and resolve quality and customer service problems. This shall include identifying trends, recommending system enhancements to Manager/Head of BU.
  • To oversee, provide co-ordination, management and supervision of long term and day to day operational related matters planning, service delivery within the areas of delegated authority.
  • To conduct Quality Assurance/ Control on regular/ routine basis ensuring efficiency, effectiveness and performance are always achieved and maintained in accordance to SLA set- forth by the clients.
  • To Identify and evaluate the risks associated with program activities and take appropriate action to control the risks ensuring operation runs smoothly without interruption. To review BCP and conduct trials in coordination of IS department.
  • In coordination of HR, to implement human resources policies, develop performance evaluation framework to assess the strengths of the staff and to identify areas for improvement.
  • To manage, appraise and review assigned staffs’ KPI. This shall include proposal of promotion and/or remuneration to Manager/Head of BU.
  • To accomplish staff performance by communicating job expectations, planning, monitoring, and appraising performance outcome.
  • With presence of a witness, to motivate, coach, counsel and discipline staff involving in misconducts and/or performance related issues.
  • To provide an effective communication link, maintain effective and appropriate relationships between the management and the areas of delegated responsibilities.
  • To coordinate the development and delivery of education and training program on aspects relating to information security, health and insurance industries for department.
  • To provide, through formal and informal interactions, appropriate support and training to Healthcare Operations Executive as and when required.
  • To provide advice, sound judgement and recommendation on case of admission that surpasses the authority of a Healthcare Operations Executive.
  • To authorise, deny and determine extent of insurer’s liability on case of discharge that surpasses the authority of a Healthcare Operations Executive.
  • Within discretion, to increase, decrease or suspend Authority of staff by reviewing performance Audit report.
  • To ensure claims recommendations and decisions are complied with legal requirements, industry regulations, company policies and professional codes. To report to Manager/Head of BU of any claims fraudulent
  • In coordination of Healthcare Cost Containment Unit (HCCU), to establish strategies to manage the cost of health insurance. Act as first guard of cost containment before escalation to HCCU.
  • To maintain excellent knowledge of products portfolio, understand clients’ needs. To work with Network and Medical Team to identify industry new practices and suggest adaption or modifications of existing practices to Manager/Head of BU.
  • To maintain quality service and close communications/ relationships with clients ensuring business retention and work closely with Marketing to identify new business opportunities.
  • To coordinate with Claims Service Unit (CSU), Claims Billing and Audit (CBA) for any claims related matters to ensure practice consistencies are met.
  • To liaise with HODs of other departments to ensure delivery of effective and efficient services to clients and/or customers.
  • In coordination of Data Team, to support the technical application of systems such as billing modalities, policies, benefit plans, systems set up and review ensuring accuracy of information is always maintained
  • In coordination of IT Team, to analyse the impact of existing and new applications. This shall include conducting tests on its stability and functionality ensuring systems operate at optimum efficiency.
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Requirements

  • Minimum qualification: Degree in relevant field.
  • Minimum experience: 7 years in the Healthcare Operations
  • Leadership exposure with similar capacity is a MUST.
  • Good level of Communication
  • A collaborative and flexible style, with a strong service mentality.
    • Communicating
    • Computing
    • Critical Thinking
    • Logical Thinking
    • Listening
    • Supervising
    • Motivating
    • Mentoring
    • Staff Managing
    • Innovating
    • Decision Making
    • Analytical Skill
    • Presentation Skill
    • Time Management
    • Claim Assessment Skills