Health Executive – Operations

About the Role

We 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.
The 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.

Key Responsibilities

Operational Leadership & Strategy

• Develop and execute operational strategy aligned with overall business objectives
• Translate strategic priorities into actionable plans across all operational divisions
• Foster a high-performance service-oriented culture
• Ensure alignment across operations product distribution and clinical teams

Oversight of Core Operational Functions

Lead and ensure performance across:

• Claims Management adjudication clinical validation fraud prevention and cost control
• Underwriting & Policy Administration risk assessment onboarding and policy lifecycle management
• Customer Service & Call Centre Operations multi-channel member and broker support
• Provider Network & Hospital Relations contracting partnerships and service quality oversight
• Membership Onboarding & Servicing seamless onboarding and ongoing member administration
• Billing Administration premium billing collections reconciliations arrears management and financial accuracy in partnership with Finance
• Virtual Care & Digital Health Services telemedicine digital platforms and remote care innovation
• Scheme / Product Administration administration of benefits and scheme rules in line with regulatory requirement

Customer & Stakeholder Experience

• Champion a customer-centric operating model
• Improve turnaround times service quality and first-contact resolution
• Build strong relationships with members providers brokers and regulators
• Monitor and enhance satisfaction and retention metrics

Financial & Performance Management

• Manage operational budgets and drive cost efficiency initiatives
• Improve cost-to-serve and operational productivity
• Establish and monitor KPIs dashboards and reporting frameworks
• Identify opportunities for operational scalability and efficiency

Governance Risk & Compliance

• Ensure adherence to all regulatory and compliance requirements
• Oversee operational risk management including fraud mitigation
• Maintain strong internal controls and audit readiness
• Partner with Risk and Compliance functions to uphold best practices

Process Optimisation & Digital Enablement

• Lead continuous improvement initiatives (Lean Six Sigma automation)
• Drive digital transformation across operational processes
• Enhance system integration data usage and decision-making capabilities
• Improve operational resilience and scalability

People Leadership & Culture

• Lead mentor and develop a team of operational leaders
• Build leadership capability and succession pipelines
• Foster an inclusive collaborative and high-performance culture
• Drive employee engagement accountability and retention

Qualifications :

Key Requirements

Qualifications

• Bachelors degree in Business Healthcare Administration Actuarial Science or related field
• Postgraduate qualification (MBA or equivalent) preferred

Experience

• 1015 years experience in health insurance medical schemes or healthcare funding
• 58 years in a senior operational leadership role
• Proven experience managing complex large-scale operational environments

Knowledge & Skills

• Strong understanding of health insurance operations and regulatory frameworks
• Financial acumen with data-driven decision-making capability
• Expertise in operational excellence methodologies
• Experience in digital transformation and process automation
• Excellent leadership communication and stakeholder management skills
• Ability to balance strategic thinking with operational execution

Leadership Attributes

• Customer-first mindset
• Results-driven with strong execution capability
• High integrity and sound judgment
• Resilient and adaptable in a dynamic environment
• Collaborative people-centered leadership style

Additional Information :

Why Join Us
This is an opportunity to shape and transform a core business function within a forward-thinking organisation. You will have the mandate to influence strategy drive innovation and lead a high-performing team in delivering exceptional service to members and stakeholders.

Remote Work :

No

Employment Type :

Full-time