Operations Manager Mozambique

Momentum Group Limited

About The Position

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Requirements

Relevant business qualification (MBA/postgraduate qualification preferred).
Extensive financial services and operational management experience.
Strong leadership and strategic management capability.
Knowledge of governance, risk, finance and operations.
Excellent communication, decision-making and stakeholder management skills.

Nice To Haves

Business Acumen
Problem solving skills
Attention to detail
Excellent written and verbal communication skills
Collaboration
Client/ Stakeholder Commitment
Impact and Influence
Drive for Results
Self-awareness and Insight
Leads Change and Innovation
Diversity and Inclusiveness

Responsibilities

Ensure that Membership, Claims, Provider Relations and Health Risk Management functions and processes operate efficiently and are user friendly to enable sustainable growth.
Ensure that we have the largest provider network possible.
Ensure that the scheme maintains an effective provider network including public sector.
Ensure that preferred pricing arrangements, with discounted rates for services are in place with top 5 service providers, to maintain scheme claims ratio of 75%.
Ensure preferential relations with providers.
Process claims accurately and effectively.
Ensure that no stale claims are approved for payment.
Prevent fraud, and the processing of fraudulent claims for payment by auditing, and reporting fraud on a quarterly basis, followed by recommendations on limiting/eradicating fraud.
Ensure that members with chronic conditions are enrolled on to the programme, and have adequate assistance.
Ensure that high-cost procedures are more flexible.
Produce the scheme rules.
Manage medical assistance (adequate, efficient and cost-effective treatments).
Ensure that inclusions and removals are flexible.
Manage Risk.
Ensure that quality control is done.
Mapping of medication.
Document and review department processes.
Regular business review.