Head of Operations - Medical Insurance

About the role

A reputable insurance company, represented by Shugulika Africa Limited, is looking for a Head of Operations to oversee its medical insurance operations and procedures. The role reports to the CEO of the Medical Division and is responsible for achieving agreed performance targets and budgets.

Key responsibilities

• Oversee the entire operations of the division and ensure income, underwriting profit and overall profitability targets are met.
• Negotiate with healthcare providers, ambulance and health education providers on prices and contract terms, and build relationships with providers across East, Asia and Southern Africa.
• Ensure provider accreditation follows company guidelines to protect claims management interests.
• Develop growth strategies for direct business, identify market opportunities, negotiate deals and develop products and services that increase market share.
• Lead employees, foster an ethical, customer-focused culture, retain the insured portfolio and maintain close ties with intermediaries.
• Analyse data and metrics to guide underwriting and claims teams on product structure, pricing and negotiations.
• Develop SOPs and guidelines for operational processes, including claims adjudication and underwriting.
• Manage medical claims, implement claims-saving strategies such as fraud detection, and run client wellness programs to reduce claims costs.
• Implement IT-driven processes, ensure the core insurance system functions and develops an annual operating plan aligned with long-term strategy.
• Protect the company's reputation with policyholders and healthcare providers and keep the CEO fully informed.

Required profile

• Bachelor's degree in insurance, finance, business or a related field; a Master's degree is an added advantage.
• Minimum 8-10 years of experience in the insurance industry.
• Demonstrated leadership experience overseeing and managing a team.
• In-depth knowledge of insurance products, policies and regulations.
• Proven track record of implementing strategic initiatives and improving processes.
• Experience managing operations in the medical department of an insurer is an added advantage.