The role of the Head of Medical Business is to provide overall leadership, including oversight of underwriting and claims, and the general management of the medical business. The successful candidate will ensure that revenue growth and targets are achieved, products offered remain competitive, and service delivery and customer service are maintained at the highest standards to ensure profitability and business sustainability.
PRINCIPAL ACCOUNTABILITIES
Strategy Development & Implementation
- Participate in the development and implementation of the overall company’s strategic plan.
- Responsible for the development and implementation of departmental strategic objectives and initiatives in line with corporate goals.
- Prepare the departmental budget and ensure adherence and minimization of expenditure to manage costs.
- Understand the value drivers of the business and identify profitable commercial opportunities to grow revenue and market share.
- Responsible for the growth of emerging markets and distribution channels.
- Build a sustainable, cost effective, impactful approach to customer acquisition, servicing model, and retention.
- Prepare, circulate, and regularly update the departmental guidelines to be followed every year.
- Assess the risks to the business on any new opportunities.
- Implement a cash and carry culture at the point of business acquisition and structured credit approval on corporate business to build liquid reserves.
- Collect relevant information and feedback from the market to be incorporated in developing innovative products to meet the changing clients’ needs.
- Supervise the medical team with a view to ensuring achievement of strategic departmental objectives and eventually company objectives in line with the strategic plan.
- Prepare medical department reports to support management decision.
Business Development
- Champion the acquisition of business in line with the Division’s growth strategy through retention, generic growth, and acquisition of new business.
- Support business development to develop strategic recommendations related to market competition, products, and pricing.
- Develop key strategic partnerships to aid in business growth and service provision.
Operations
- Review the risks accepted in the company to ensure that they are within the set underwriting guidelines and are covered under the reinsurance program.
- Provide guidance to the underwriting team on various enquiries for risk acceptance.
- Manage the renewal process to achieve the set turnaround time for issuance of renewal notices and deliver the desired retention; directly negotiate major corporate renewals to achieve the set business retention parameters.
- Provide technical expertise on rates review depending on specific class loss ratio.
- Ensure performance is within the set loss ratio.
- Set up authority levels in the department and ensure adherence to set levels.
- Develop relationships with existing clients, intermediaries, and financial institutions to ensure continued business growth.
- Ensure continuous audit of all systems and procedures are carried out, along with data audit for integrity and correctness at all times.
- Manage relationships with clients, intermediaries, and service providers to ensure agreed service level agreements are achieved and goodwill with all stakeholders is maintained.
- Effectively manage the credit control status to ensure that premium payment is done on a timely basis.
- Medical claims Management – Ensure medical claims are processed in time, audited, fraud detection is implemented, and claim cost is reduced.
Provider Management
- Manage the health service provider network for efficiency and effectiveness in service delivery, and facilitate their bills settlement within set parameters.
- Review service providers to ensure quality in service provision and good outcomes.
Care Management
- Developing, reviewing, and implementing an effective and efficient care management system.
- Engaging service providers on the health of clients to maximize benefits from their covers.
- Ensure customers receive high quality medical care at a reasonable cost through daily audit and concurrent review of all admissions.
Staff Management
- Provide leadership to the medical team through training and staff motivation to achieve the medical unit objectives.
- Conduct performance management processes from setting key performance indicators with staff in the department, review of performance, and continuous coaching and mentoring in the department, as per company guidelines.
Risk & Compliance
- Ensure compliance with regulatory requirements and all regulatory bodies (i.e., IRA/AKI).
- Ensure that all activities and duties are carried out in compliance with all regulatory requirements, Operational Risk Framework, and internal policies & Standards.
- Manage the implementation of internal and external audit and risk recommendations within the agreed timelines.
KNOWLEDGE AND EXPERIENCE
Qualifications:
- A Bachelor’s degree in Business Related Course/ Actuarial Science/ Medical Related course.
Professional Qualifications
- Diploma in Insurance (ACII / AIIK).
- Member of a relevant professional body.
Experience:
- Nine (9) years’ relevant working experience, four (4) of which should have been at manager level and above in a similar role.
Knowledge
- A strong understanding and experience of the insurance industry and Healthcare in Kenya.
SKILLS AND COMPETENCIES
- Strong Leadership skills with ability to motivate and inspire teams.
- Problem solving and conflict resolution.
- Client Management and Negotiation skills.
- Risk management and analytical skills.
- Good communication skills and Interpersonal relationship.
- Highest level of personal and professional integrity.
- Emotional Intelligence.
- Visionary.
- Relationship Building.
- Strategic Thinking.
- Commercial Acumen.
- Stakeholder Management.
