The Social Health Authority (SHA) Hiring Senior Benefits Management Officer 

Minimum Qualifications:

Bachelors Degree

Job Term:

Permanent and Pensionable

Position Level:

SHA 6

Number of positions:

2

Qualifications, Skills and Experience Required:

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

1. 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.
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. Shown merit and ability as reflected in work performance and results.
5. Proficiency in computer applications.

Responsibilities:

1. Undertaking operational planning for Health Benefits management, risk assessments and monitoring performance against strategic objectives in collaboration with other departments.
2. Formulating and implementing policies and strategies for effective and efficient Health Benefits management in collaboration with other departments.
3. 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.
4. Collaborating with the health Benefits Package & Tariffs Advisory Panel in evidence-based designing, reviewing, and updating of Benefit packages and Tariffs.
5. 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.
6. Analyzing cost-effectiveness, affordability, budget impact of health benefit offerings and recommending optimizations to maintain sustainability.
7. 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.
8. Implementing and continuously improving of Benefits and Tariffs management information systems, ensuring they support efficient operations and member satisfaction.
9. Analyzing data for purposes of claim management in collaboration with other departments.
10. Analysing the cost-effectiveness of benefit offerings and recommend optimization to maintain sustainability
11. Collaborating 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.

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