Overview
Role Purpose: This role offers exciting and challenging opportunities for a dynamic, performance-oriented, knowledgeable, and experienced individual. The candidate must deliver quality outputs in a fast-paced, high-volume client-oriented environment, excelling both independently and as part of a team. This position is essential for maintaining and improving the quality standards across the organisation, ensuring exceptional client service and operational efficiency.
Qualifications
- Valid Matric Certificate
- Proven process specialisation with a medical scheme administration
- Experience in quality assessment within a medical scheme administration business
- Subject management experience relative to allocated stakeholder areas and proven proficiency at an advanced level
- Strong performance orientation
- Knowledge of the scheme''s rules and benefits
- Competence in generating quality and statistical reports
- Familiarity with all operational processes employed within the administration business
- Proven specialisation in delegated process focus areas
Skills
- Ability to remain impartial
- High focus on customer expectations and experience
- Ability to maintain cooperative working relationships
- Ability to work independently and as part of a team
- Ability to give constructive feedback and coach
- Analytical and problem-solving skills with the ability to make decisions
- Ability to communicate recommendations in a constructive manner
- Excellent interpersonal and communication skills (written and verbal)
- Strong client service and relationship management skills
Experience
- More than 2 years proven experience within designated process focus area within a medical scheme administration business
- Proven specialisation courses within designated process focus area within a medical scheme administration business
- Proven exceptional quality scores/outcomes in experience process areas
Duties and Responsibilities
- Internal Process
- Conduct daily quality checks for all operational areas as directed by the scheme, including: correspondence management; call- and walk-in centre operations; enquiry management; claims processing; ex-gratia; membership services; underwriting; customer experience
- Weekly quality checks and revision of cases shared by the technical department with updates on the QA database
- Coaching: notify employees assessed of QA outcomes; schedule and conduct coaching sessions
- Record keeping: maintain valid, accurate, and up-to-date records of employees assessed
- Issue notifications and promptly inform team coaches of QA issues
- Ensure timely investigations and task completion from QA findings
- Attend stakeholder meetings and share QA learnings; ensure timely completion of investigations
- Engage regularly with assessed employees and leaders
- Continuous Development
- Stay informed about developments within Metropolitan Health, particularly People, Process and System changes
- Communicate changes with QA leaders to ensure alignment of QA training and QA processes
- Knowledge Enhancement
- Understand the scheme''s Rules and Benefits; attend annual updates
- Maintain up-to-date knowledge for allocated areas to be a subject matter expert
- Proactively drive enhancements
- Quality Statistics Reporting
- Capture quality outcomes for all assessments to enable detailed reporting and insights for stakeholders
- Client
- Build and maintain relationships with designated stakeholder groups (clients & internal stakeholders)
- Deliver on service level agreements to manage client expectations
- Make recommendations to improve client service and fair treatment within the area of responsibility
- Contribute to a culture of rewarding relationships, feedback, and exceptional client service
- Monitor turnaround times and quality standards; resolve issues swiftly
- Manage client query processes, track queries, resolve them, and use insights to improve service
- People
- Build strong relationships by providing specialist know-how and leadership
- Continuously develop own expertise and apply it in specialisation
- Influence and manage change; provide specialist support as required
- Contribute to continuous innovation and a culture of quality management
- Take ownership of driving career development
- Finance
- Contribute to area budgets to minimise expenditure and improve efficiency
- Identify solutions to enhance cost-effectiveness
- Provide input into governance processes and escalate unresolved issues
- Note: Provide input into risk identification processes and communicate recommendations to ensure QA framework alignment.
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