Senior Benefits Management Officer - 2 Posts at The Social Health Authority (SHA)

Qualifications, Skills and Experience Required:

Person Specifications: For appointment to this grade, a candidate must have:

• Cumulative service period of six (6) years’ relevant work experience, three (3) of which should have been at the grade of Benefits Management Officer I or in a comparable position.
• Bachelor’s degree in any of the following disciplines: Pharmacy, Health Financing, Health Economics, Actuarial Sciences, Statistics, Nursing, Mathematics, Dentistry, or its equivalent from a recognized institution.
• Membership with a relevant professional body, where applicable and in good standing.
• Shown merit and ability as reflected in work performance and results.
• Proficiency in computer applications.

Responsibilities:

• Undertaking operational planning for Health Benefits management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments.
• Formulating and implementing policies and strategies for effective and efficient Health Benefits management in collaboration with other departments.
• Supporting Strategic purchasing of prescribed benefit packages in close collaboration with the Directorate of Fund Management and other departments ensuring efficiency, equity, and cost-effectiveness in service delivery.
• Collaborating with the health Benefits Package & Tariffs Advisory Panel in evidence-based designing, reviewing, and updating of Benefit packages and Tariffs.
• Implementing prescribed Benefits packages and Tariffs under various funds (Primary Healthcare Fund, Social Health Insurance Fund, Emergency, Chronic and Critical Illness Fund) for different levels of providers and facilities.
• Analyzing cost-effectiveness, affordability, budget impact of health benefit offerings and recommending optimizations to maintain sustainability.
• Collaborating with the Benefit Package & Tariffs Advisory Panel, ensuring the benefits packages and tariffs design, review and implementation processes are transparent and inclusive through stakeholder engagement.
• Implementing and continuously improving of Benefits and Tariffs management information systems, ensuring they support efficient operations and member satisfaction.
• Analyzing data for purposes of claim management in collaboration with other departments.
• Analysing the cost-effectiveness of benefit offerings and recommend optimization to maintain sustainability
• Collaborating with external stakeholders to ensure transparency and trust.
• Implementing robust internal controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders.
• Ensuring compliance with local and international standards in Benefits Management (as prescribed in the Act), fostering alignment with globally recognized best practices and enhancing the Authority’s reputation.
• Implementing policies and strategies for business process re-engineering, driving innovation and efficiency in Benefits Management.
• Providing expert guidance in Benefits management on reviewing and amending the Social Health Insurance Act, ensuring responsiveness to the evolving healthcare landscape and adherence to quality standards.