Benefits Management Officer I Jobs at The Social Health Authority (SHA)

Minimum Qualifications:
Bachelors Degree
Job Term:
Permanent and Pensionable
Position Level:
SHA 7
Number of positions:
4

Qualifications, Skills and Experience Required:
For appointment to this grade, a candidate must have:
1. Cumulative service period of three (3) years’ work experience at the grade of Benefits Management Officer II or in a comparable position;
2. 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;
3. Membership with a relevant professional body, where applicable and in good standing;
4. Proficiency in computer applications; and
5. Shown merit and ability as reflected in work performance and results.

Responsibilities:
You will assist in implementing the operational plan for Health Benefits management, including risk assessments, strategic purchasing of benefit packages, and analysis of cost-effectiveness.

Key Responsibilities
1. Implementing operational plan for Health Benefits management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments.
2. Implementing of policies and strategies for effective and efficient Health Benefits management in collaboration with other departments.
3. Participating in the 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.
4. Carrying out collaborations with the health Benefits Package & Tariffs Advisory Panel in evidence-based designing, reviewing, and updating of Benefit packages and Tariffs.
5. Implementing the prescribed Benefits packages and Tariffs under the Primary Healthcare Fund for level 2, 3 and select 4 providers and facilities; under the Social Health Insurance Fund in level 4, 5 and 6 providers and facilities and the Emergency, Chronic and Critical Illness Fund in level 2-6 facilities and providers.
6. Analysing the cost-effectiveness, affordability, budget impact of health benefit offerings and recommend optimizations to maintain sustainability.
7. Collaborating with the Benefit Package & Tariffs Advisory Panel, ensure the benefits packages and tariffs design, review and implementation processes are transparent and inclusive through stakeholder engagement.
8. Implementing and improving Benefits and Tariffs management information systems, ensuring they support efficient operations and member satisfaction.
9. Collecting and analysing data for purposes of claim management in collaboration with other departments.
10. Analysing data for reports on Benefits Management Analyse the cost-effectiveness of benefit offerings and recommend optimizations to maintain sustainability.
11. Supporting effective collaboration with external stakeholders to ensure transparency and trust.
12. Implementing robust internal controls to safeguard the sustainability, affordability, and integrity of benefits packages for all stakeholders.
13. 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.
14. Implementing policies and strategies for business process re-engineering, driving innovation and efficiency in Benefits Management.
15. 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.