Administration and Authorisations Manager – Pet and Health Care (Insurance industry) at Oneplan Underwriting Managers (Pty) Ltd

Duties & Responsibilities:

Authorisation Management:

• Oversee the entire insurance authorisation process for hospital services, including surgeries, treatments, and diagnostic procedures.
• Ensure all necessary documentation, including medical records, is submitted accurately and in a timely manner.
• Ensuring productivity and execution of authorisations are done timeously.
• Resolve issues with denied claims, claim queries or delayed authorisations.

Administrative Operations: 

• Supervise administrative staff responsible for managing patient / client registrations, billing, and other clerical functions.
• Implement efficient administrative workflows and ensure proper record-keeping.
• Collaborate with clinical departments to ensure smooth coordination between administrative and administrative functions from suppliers.
• Monitor compliance with health and safety regulations, data protection laws, and health care policies.

Financial Oversight:

• Collaborate with the finance department to track and monitor administration and authorisations for payment processing.
• Ensure accurate billing and timely invoicing based on authorized services.
• Oversee cost estimates for claims and review concerns related to the product policies for approval of claims.

Team Leadership:

• Lead and develop a team of administrative and authorisation staff, providing training and mentoring as needed.
• Set performance goals for the team and ensure they meet the established standards.
• Conduct performance reviews and provide ongoing feedback for team improvement.

Compliance & Reporting:

• Ensure adherence to all legal, regulatory, and accreditation standards related to hospital administration and insurance practices.
• Prepare regular reports on authorisations, denials, and pending claims for senior management.
• Maintain records of all authorizations, including dates, approvals, denials, and appeals.

Key Performance Indicators (KPIs):

Authorisation Approval Rate:

• Percentage of authorization requests approved on the first submission.
• Average time taken to secure approvals from insurance companies.

Claims Denial Resolution:

• Rate of resolved denied claims.
• Time taken to appeal, and resolve denied claims.

Client Satisfaction:

• Patient feedback on administrative processes, particularly regarding billing and insurance communication.
• Timeliness in addressing patient concerns and questions.

Operational Efficiency:

• Reduction in administrative processing times for admissions and discharges.
• Efficiency in coordinating patient authorizations with clinical schedules.

Team Performance:

• Achievement of team-based goals (e.g., meeting deadlines, accuracy of submissions).
• Staff retention and satisfaction within the administrative team.

Compliance Adherence:

• Zero incidents of non-compliance with health, safety, and insurance regulations.
• Number of audits passed with minimal issues.

Requirements

Key requirements of the role:

Education:

• Bachelor’s degree in business financial administration (BCom) and or Bachelor of science (BSc) or a related field, would be advantageous.
• Medical workplace experience working within a hospital or medical center for 2-3 years.
• Qualified Nurse with 3-5 years’ experience within the Health Service would be advantageous.
• Additional certifications in healthcare management or insurance billing are a plus.

Experience:

• 5+ years of experience in healthcare administration, including at least 2 years in an insurance authorisation or billing role.
• Proven experience managing a team in a healthcare setting.
• In-depth knowledge of health insurance policies, reimbursement processes, and authorization procedures.
• Familiarity with hospital administrative processes and insurance claim systems.
• Proficient in office management software and Microsoft Office Suite.
• Strong organizational and leadership skills.
• Excellent communication and interpersonal abilities.
• Ability to multitask and prioritize effectively in a fast-paced environment.
• Problem-solving skills and attention to detail.
• Highly administrative and accurate in execution of tasks.
• Proven experience as an Admin Manager or in a similar role, including motivating of staff and ensuring the team is highly productive.