Manager: Masterfiles at Momentum Metropolitan Holdings Limited

Role Purpose    

The role is responsible for the management of all price files in the Business System Solution area including the management of:

• Scheme, Modifier and Network rates
• Maintenance of network providers
• Maintenance of relative value units RVU
• Maintenance of rand conversion factors RCF
• Escalated tariff related queries
• Reporting on tariff discipline related queries
• Maintenance of Provider Masterfile
• Claims reprocessing

Requirements    

• Matric (Grade 12)
• Business or Management degree or studying towards will be advantageous
• Minimum of 3 - 5 years' experience in the claims operations environment is essential
• In depth understanding of reference price lists and industry standard pricing structure is essential
• A clinical qualification or extensive clinical knowledge will be advantageous
• High level of proficiency in Healthcare and Medical Scheme administration landscape

Duties & Responsibilities    

Operational Management

• Managing the day-to-day operational functions by ensuring Momentum Health Solutions meets and exceeds SLA’s.
• Provide insights into what is driving transactional trends and provide innovative solutions to improving unnecessary volumes into Momentum Health Solutions environment.
• Actively pursue improvement in quality of back-office function processing.
• Oversee enquiry investigations and ensure that responses are comprehensive and well-constructed.
• Participate in regular operational and other forums as required by clients All Momentum Health Solutions clients).
• Creating a positive working environment and optimise human capital outputs and quality.
• Management of Leave, overtime and productivity for team.

Performance Management of team.

• Report on monthly / quarterly performance for the area under review as required by Scheme / Internal Stakeholders.
• Manage departmental budgets and employer asset base (hardware, software etc.)
• Ensure functional compliance with the Medical Scheme's Act.

Audit Function

• Ensure that functional area perfects audit findings and where these occur facilitate remediation within timelines agreed with internal/external auditors.

Stakeholder Management

• Drive collaboration with internal stakeholders to ensure optimal value chain service delivery.
• Develop sound relationships with customer in order to foster trust and credibility.
• Attend industry platforms to ensure MH visibility.
• Ensure compliance with internal and external requirements.

Competencies    

• Business Acumen
• Client / Stakeholder Commitment
• Drive for Results
• Leads change and Innovation
• Motivating and Inspiring Team
• Strategic Thinking
• Collaboration
• Impact and Influence
• Self-Awareness and Insight
• Diversity and Inclusiveness
• Growing Talent

Closing Date    

• 2026/04/03