Job Description<\/p>\n
About the Role<\/p>\n
\tWe are seeking an experienced and strategic Health Executive: Operations to lead and optimise all operational functions within our health insurance business. This is a critical executive leadership role responsible for ensuring the efficient, compliant, and customer-centric delivery of services across the full operational value chain.
\n\tThe successful candidate will play a key role in driving operational excellence, enhancing member and stakeholder experience, and enabling sustainable business growth through strong leadership, governance, and continuous improvement.<\/p>\n
Key Responsibilities
\nOperational Leadership & Strategy<\/p>\n
\tDevelop and execute operational strategy aligned with overall business objectives
\n\tTranslate strategic priorities into actionable plans across all operational divisions
\n\tFoster a high-performance, service-oriented culture
\n\tEnsure alignment across operations, product, distribution, and clinical teams<\/p>\n
Oversight of Core Operational Functions
\nLead and ensure performance across:<\/p>\n
\tClaims Management\u00a0\u2013 adjudication, clinical validation, fraud prevention, and cost control
\n\tUnderwriting & Policy Administration\u00a0\u2013 risk assessment, onboarding, and policy lifecycle management
\n\tCustomer Service & Call Centre Operations\u00a0\u2013 multi-channel member and broker support
\n\tProvider Network & Hospital Relations\u00a0\u2013 contracting, partnerships, and service quality oversight
\n\tMembership Onboarding & Servicing\u00a0\u2013 seamless onboarding and ongoing member administration
\n\tBilling Administration\u00a0\u2013 premium billing, collections, reconciliations, arrears management, and financial accuracy in partnership with Finance
\n\tVirtual Care & Digital Health Services\u00a0\u2013 telemedicine, digital platforms, and remote care innovation
\n\tScheme \/ Product Administration\u00a0\u2013 administration of benefits and scheme rules in line with regulatory requirement<\/p>\n
Customer & Stakeholder Experience<\/p>\n
\tChampion a customer-centric operating model
\n\tImprove turnaround times, service quality, and first-contact resolution
\n\tBuild strong relationships with members, providers, brokers, and regulators
\n\tMonitor and enhance satisfaction and retention metrics<\/p>\n
Financial & Performance Management<\/p>\n
\tManage operational budgets and drive cost efficiency initiatives
\n\tImprove cost-to-serve and operational productivity
\n\tEstablish and monitor KPIs, dashboards, and reporting frameworks
\n\tIdentify opportunities for operational scalability and efficiency<\/p>\n
Governance, Risk & Compliance<\/p>\n
\tEnsure adherence to all regulatory and compliance requirements
\n\tOversee operational risk management, including fraud mitigation
\n\tMaintain strong internal controls and audit readiness
\n\tPartner with Risk and Compliance functions to uphold best practices<\/p>\n
Process Optimisation & Digital Enablement<\/p>\n
\tLead continuous improvement initiatives (Lean, Six Sigma, automation)
\n\tDrive digital transformation across operational processes
\n\tEnhance system integration, data usage, and decision-making capabilities
\n\tImprove operational resilience and scalability<\/p>\n
People Leadership & Culture<\/p>\n
\tLead, mentor, and develop a team of operational leaders
\n\tBuild leadership capability and succession pipelines
\n\tFoster an inclusive, collaborative, and high-performance culture
\n\tDrive employee engagement, accountability, and retention<\/p>\n
Qualifications<\/p>\n
Key Requirements<\/p>\n
Qualifications<\/p>\n
\tBachelor\u2019s degree in Business, Healthcare Administration, Actuarial Science, or related field
\n\tPostgraduate qualification (MBA or equivalent) preferred<\/p>\n
Experience<\/p>\n
\t10\u201315 years\u2019 experience in health insurance, medical schemes, or healthcare funding
\n\t5\u20138 years in a senior operational leadership role
\n\tProven experience managing complex, large-scale operational environments<\/p>\n
Knowledge & Skills<\/p>\n
\tStrong understanding of health insurance operations and regulatory frameworks
\n\tFinancial acumen with data-driven decision-making capability
\n\tExpertise in operational excellence methodologies
\n\tExperience in digital transformation and process automation
\n\tExcellent leadership, communication, and stakeholder management skills
\n\tAbility to balance strategic thinking with operational execution<\/p>\n
Leadership Attributes<\/p>\n
\tCustomer-first mindset
\n\tResults-driven with strong execution capability
\n\tHigh integrity and sound judgment
\n\tResilient and adaptable in a dynamic environment
\n\tCollaborative, people-centered leadership style<\/p>\n
Apply via company website ( N \/ A ) or<\/p>\n
jobs.smartrecruiters.com<\/p>\n
<\/p>\n","protected":false},"author":2,"featured_media":0,"template":"","meta":{"_promoted":"","_job_location":"","_application":"http:\/\/jobs.smartrecruiters.com","_company_name":"Kaelo","_company_website":"http:\/\/N%20\/%20A","_company_tagline":"Kaelo provides innovative, essential, healthcare solutions enabling the physical and psychological well-being of all South Africans. Our one goal is to provide more South Africans with access to quality healthcare. We are progressive in our design, simple in our approach and sincere in the way we... read more engage, changing the way healthcare is delivered to meet the needs of our people.","_company_twitter":"","_company_video":"","_filled":0,"_featured":0,"_remote_position":0,"_job_salary":"","_job_salary_currency":"","_job_salary_unit":""},"job_listing_region":[11],"job-types":[12],"class_list":{"0":"post-33265","1":"job_listing","2":"type-job_listing","3":"status-publish","4":"hentry","5":"job_listing_region-gauteng","7":"job-type-full-time"},"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-listings\/33265","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-listings"}],"about":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/types\/job_listing"}],"author":[{"embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/users\/2"}],"wp:attachment":[{"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/media?parent=33265"}],"wp:term":[{"taxonomy":"job_listing_region","embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job_listing_region?post=33265"},{"taxonomy":"job_listing_type","embeddable":true,"href":"https:\/\/jobs.dataaxisnode.com\/southafrica\/wp-json\/wp\/v2\/job-types?post=33265"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}