Job purpose:

To lead and manage the Policy Administration Pre-Inception and Contracting team, ensuring the efficient and accurate processing of administrative tasks within the medical health insurance sector. This role is pivotal in optimizing administrative procedures, maintaining compliance with regulatory standards, and providing exceptional support to clients, intermediaries, and internal teams. The Team Leader is responsible for fostering a high-performance culture through effective coaching, resource management, and continuous improvement initiatives, ensuring that customer, client, and broker needs are met with the highest standards of service quality.

Key Responsibilities:

1. Team Leadership, Performance & Resource Management

Supervise and coordinate onboarding, Pre-Inception, administrative and contracting activities, ensuring adherence to operational policies, procedures and agreed standards for policy onboarding and maintenance.
Plan and coordinate administrative procedures and systems and identify opportunities to streamline processes and improve efficiency.
Assess staff performance and provide coaching and guidance to maximize efficiency, transaction quality and professional development.
Conduct required coaching sessions for team members, both side-by-side and remotely, to monitor performance development and transaction quality.
Foster a positive, collaborative and high-performance team environment, promoting professional growth and development.
Monitor SLA, turnaround time, cycle time, quality, productivity and other relevant operational measures and support corrective actions where required.
Allocate resources and skills according to workload and business priorities, particularly during peak periods, to maintain operational continuity and service levels.
Prepare and present regular reports on team performance, operational metrics, compliance and regulatory status to senior management.
Prepare regular operational, performance, compliance and regulatory reports as required.

2. Policy Administration, Pre-Inception, Onboarding & Contracting

Ensure accurate and timely execution of policy administration, pre-inception, onboarding, maintenance and contracting activities across relevant lines of business and business channels.
Review all documents received to ensure completeness, accuracy and appropriate administration in healthcare systems, maintaining high-quality inputs within agreed SLAs.
Maintain physical and electronic records relating to medical insurance policies, onboarding and maintenance requests.
Provide full administrative support to clients, policyholders, brokers and intermediaries.
Support the implementation of standard onboarding processes and workflows across business channels to meet SLA and cycle-time targets.
Monitor and communicate the impact of workflow and process changes on onboarding and related departments throughout the end-to-end process.
Ensure department tasks and individual assignments are completed within agreed turnaround times for all transaction types.
Maintain service level agreements for all transaction types across lines of business while upholding high standards of customer, client and broker service.
Upload member data files to regulatory systems and ensure submissions comply with applicable directives and requirements.
Translate policy contracts and marketing collateral as required.

3. Quality, Compliance, Controls & Audit

Achieve and maintain regulatory compliance through continuous monitoring and reporting of process, procedure and system gaps.
Conduct quality assurance activities to ensure high standards of service delivery and transaction quality.
Support internal and external inspections, audits and investigations and ensure compliance with regulatory standards and internal policies.
Identify, document and follow up on process, procedure, system and control gaps and support remedial actions where required.
Maintain accurate records and evidence required for regulatory, operational and quality assurance purposes.

4. Training, Competency & Knowledge Management

Conduct needs assessments and gap analyses and develop and deliver training on systems, processes, procedures and guidelines for policy administration and onboarding teams.
Train all new recruits on policy, provide competency assessments.
Monitor training and competency results and take remedial action where scores fall below the required standard.
Develop and implement training to enhance team skills, knowledge and operational capability.
Aid the timely dissemination of new information on products, services and procedures to enhance service quality and mitigate operational issues.
Participate in the implementation and execution of change requests and projects related to policy administration, pre-inception, onboarding and contracting.
Promote a continuous improvement mindset and identify opportunities to enhance processes, reduce issues and improve service quality.

Operational & Technical Responsibilities:

Good knowledge of healthcare insurance operating systems, processes and procedures.
Good knowledge of healthcare operations and the functions within operations.
Quality management and coaching.
Ability to understand operational requirements arising from product updates, cover changes, process changes and system changes and translate them into effective training and implementation activities.
Ability to work with healthcare administration software and systems and support system testing, issue identification and resolution.
Ability to interpret policy administration requirements and maintain accurate, compliant system inputs and records.

Essential Requirement:

Bachelor's degree in business administration, Healthcare Management, or a related field.
Minimum of 5 years of experience in policy administration or a related role within the medical health insurance industry.
Strong knowledge of medical health insurance policies and regulatory requirements.
Proven ability to plan and coordinate administrative procedures and systems.
Excellent leadership and team management skills, with experience in coaching and performance assessment.
Exceptional organizational skills and attention to detail.
Proficiency in using healthcare administration software and systems.
Strong problem-solving skills and ability to handle escalated issues.
Excellent communication and interpersonal skills.
Ability to manage multiple tasks and meet tight deadlines.
Strong understanding of regulatory compliance in the healthcare sector.
Ability to liaise effectively with cross-functional teams and external stakeholders.
Flexibility to adapt to industry trends and regulatory changes.
Experience supporting policy administration, onboarding, Pre-Inception and/or contracting activities within medical health insurance.

Policy Administration Team Leader Health Insurance