Operations Manager – Mozambique

About the role

The Operations Manager will oversee Membership, Claims, Provider Relations and Health Risk Management functions in Mozambique, ensuring they operate efficiently, are user‑friendly and support sustainable growth of the scheme.

Key responsibilities

• Develop and maintain the largest possible provider network, including public‑sector partners.
• Negotiate preferred pricing with top service providers to keep the scheme’s claims ratio around 75%.
• Process claims accurately, eliminate stale claims, and audit for fraud on a quarterly basis.
• Enroll members with chronic conditions into appropriate programmes and provide necessary assistance.
• Ensure flexibility for high‑cost procedures and manage medical assistance efficiently.
• Produce and update scheme rules, manage inclusions and removals, and conduct regular business reviews.
• Implement risk‑management controls, quality‑control checks, and medication mapping.
• Document and continuously improve department processes.

Required profile

• Relevant business qualification; MBA or postgraduate degree preferred.
• Extensive experience in financial services and operational management.
• Strong leadership, strategic management and stakeholder‑management capabilities.
• Solid knowledge of governance, risk, finance and operations.
• Excellent communication and decision‑making skills.

Required skills