Job Description

Closing Date 2025/07/30
Reference Number MMH250711-4
Job Title Head: Claims
Position Type Permanent
Role Family Client Services
Cluster Momentum Health
Remote Opportunity Some of the time
Location - Country South Africa
Location - Province Gauteng
Location - Town / City Centurion
Introduction
Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role Purpose To oversee and take accountability for key claims functions and as a result ensure that the business continues to efficiently and effectively provide leading administrative services to the scheme and its members. Provide strategic and proactive assistance to the claims functions in managing the business unit. Further to this, ensure standardisation, consistency and optimisation of processes across claims administration.
Requirements

• A post-graduate degree or MBA. (Desirable)
• Degree in Business Administration or related field. (Essential)
• Matric. (Essential)
• 8 - 10 years of experience in a service and/or claims enviroment.
• 3 - 5 years of management experience within a similar enviroment
• Experience managing a budget.
• Proven track record of driving successful performance outcomes and accomplishing organisational goals.
• Experience anticipating and responding to the needs of internal and external customers
• A very strong Finance and Operational management background.
• Comfortable to engage at with stakeholders on a senior level.
• Strong financial and business acumen.
• Knowledge of budgeting and forecasting methodologies.

Duties & Responsibilities
PROCESS

• Oversee and provide strategic management, leadership, and guidance to the Claims department
• Ensure that all service level agreements are met at all times and enhanced to remain competitive and relevant.
• Provide input to the strategy of the Business Unit as it relates to the area of responsibility and operational performance.
• Ensure that cost savings and revenue generation mechanisms are established and implemented in line with the strategic objectives.
• Provide ongoing proactive and strategic input to our client on service-related trends through insightful analysis and interpretation.
• Provide support and insight to effect performance enhancements in a timely manner across all business processes, irrespective of the department.
• Formulate strategies and guidelines (aligned to best business practices/protocols) to improve the claims area and overall business environment.
• Make recommendations and support the implementation of new business processes, new systems, and business processes relevant to the Claims and related service areas.

CLIENT

• Manage relationships of internal and external stakeholders relevant to claims matters.
• Share within the claims department and the broader business, thoughts and suggestions on potential performance and quality improvements related or unrelated to the portfolio responsible for and ensure the effective roll-out of identified improvements.
• Participate in matters affecting the broader business and provide input as and when required.
• Participate in industry and other professional networks/forums to ensure awareness of industry standards, trends and best practices in order to strengthen organisational and technical knowledge

PEOPLE

• Create awareness of the business unit's strategic objectives and their alignment to the organisational strategic objectives.
• Ensure consistent compliance to company policies and procedures, corporate governance and relevant legislative requirements.
• Provide leadership, guidance, coaching and mentoring to employees reporting to this portfolio.
• Through ethics awareness strategies, comply, champion, and encourage ethic interventions in the organisation and team on ethics and the broader vision and strategy for transformation.
• Monitor on an ongoing basis the training and development needs of employees within the portfolio.
• Provide clear related succession plans for all key positions reporting directly to this portfolio to ensure that succession planning is achieved, and that employees in this portfolio are developed to achieve their objectives and goals.
• Manage the performance of staff within the expected levels of performance objectives and recognise and reward value-added performance in line with Investors in People (IiP) standards.
• Determine appropriate staffing levels within the department, taking cognizance of the constant growth and align to employment equity principles to achieve transformation targets and objectives in line with the business unit strategic plan.
• Provide transformation interventions on areas that require immediate attention in order to create harmonization and thereby accelerating performance.

FINANCE

• Implement and compile budgets to minimise expenditure in alignment with tactical delivery plans.
• Control the budget for the area, including the authorisation of expenditures and implementation of financial Manage high risk and problematic financial issues in area of accountability and contribute to the development of policy.
• Plan and implement a cycle of medium-term improvements to drive pricing of services and products.
• Implement and manage financial risk methodologies, techniques and systems and use to monitor and report on financial activities.
• Implement and provide feedback on the effectiveness of financial policy, practice and procedures: preventing illegal, unethical or improper conduct.
• Implement risk management, governance and compliance policies in own practice area, to identify and manage governance and risk exposure liability.
• Investigate reported willful acts of non-compliance to organisation policy and practice and report on findings.

Competencies

• Communication skills (written and verbal)
• Customer relationship management (CRM) skills
• Accounting skills
• Administrative skills
• Analytical skills
• Leadership skills

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.