Accountable for the provision of specialist knowledge, delivery plans and associated practices of clinical data requirements through the extraction, analysis, validation and modelling of data with the purpose of drawing conclusions to drive clinical and operational decision making within the Scheme
Key Areas of Responsibility
- Establish working relationships with the business areas to identify gaps and business needs, and analyse and improve where required through the use of key data gathering, analysis and inferences.
- Develop and implement a framework of databases, data collection systems, data analytics dashboards and other strategies that optimise statistical efficiency and quality to inform key business decisions.
- Collate information in a meaningful way, from primary or secondary data sources (third party providers) for the purpose of analysis.
- Act as gatekeeper for data, managing data integrity and ensuring data is accurate before analysis and reporting.
- Provide accurate organisational analytics in a number of formats including dashboards, graphs, charts and reports.
- Develop analytical models that manage data intelligently in order to generate insightful information and identify trends and patterns in complex data sets.
- Develop user-friendly and accurate reports to monitor application of Scheme Rules and identify trends for high cost driver areas.
- Analyse, integrate and manage data with current and planned data systems.
- Create and interpret reports to determine return on investment of the respective managed healthcare provider.
- Lead clinical data management studies to announce protocols to effect relevant cost savings.
- Keep informed of best practice and technological developments in order to recognise improvement opportunities and articulate the potential benefits these could bring to the Scheme.
- Develop and implement specific procedures to give input into product design and specific cost containment exercises.
- Develop, review and maintain the hospital discount calculation model and ensure that payment of hospital discount is received from the hospital networks and collected quarterly.
- Monitor data base statistics for completeness and accuracy.
- Coordinate and facilitate end-to-end project management principles for multiple projects and provide updates accordingly, to the relevant stakeholders.
- Provide input into the division’s risk register in consultation with the Manager: ARC.
- Ensure the mitigation of the division’s risk profile through the application of fraud controls and risk prevention principles and implementing of sound governance and compliance processes and tools to identify and manage risks.
- Responsible for the coordination and maintenance of quality risk management in line with the requirements from ISO9001:2015.
- Monitor changes in the regulatory environment and ensure that appropriate operational controls are implemented to address new requirements.
- Support and provide evidence to all internal, external and ISO audit requirements.
- Oversee the maintenance and enforcement of all clinical risk related Service Level Agreements to minimise business risk and ensure business continuity.
- Ensure adherence to all relevant laws, policies and Standard Operating Procedures throughout the organisation.
- Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing and integration.
- Represent and participate in the organisation’s committees and tasks teams when required.
- Convene and attend meetings and present findings and business cases to relevant stakeholders when required.
- Implement timeous communication on progress and challenges in achieving the tactical work plans to impacted stakeholders.
- Attend industry related forums, conferences and workshops to gain industry insight for the purpose of business improvement
QUALIFICATIONS AND EXPERIENCE
- Degree in Information Managerment, Data Modelling for Statistics
- 5 years Medical Insurance experience
- 5 years Data Analytics experience
- Medical Insurance
- Data Analytics
- Data Modelling
- Information Management