Job Title: Policy Management Officer
Department: Policy Management / Operations
Job Description: -
The Policy Administration Officer is responsible for the accurate and timely administration of health insurance policies, including policy setup, membership management, endorsements, renewals, and ongoing policy maintenance.
The role ensures that all policy information and membership records are correctly maintained across internal systems and aligned with the contractual terms agreed with insurers and clients.
The successful candidate will work closely with insurers, brokers, internal departments, and international TPA partners to ensure seamless policy implementation, data integrity, operational efficiency, and high service standards.
Key Responsibilities
- Coordinate new health insurance policy onboarding, setup, and activation.
- Review policy documentation and ensure accurate configuration of benefits, coverage conditions, and membership categories.
- Validate policy details, including effective dates, geographical coverage, eligibility, and network arrangements.
- Manage member enrolments, additions, deletions, amendments, and endorsements.
- Validate membership data and process individual and bulk uploads.
- Maintain accurate membership records, resolve discrepancies, and coordinate membership card issuance within agreed SLAs.
- Coordinate policy renewals, ensuring timely updates to membership information and coverage conditions.
- Process authorized policy amendments and monitor policy expirations to ensure continuity of coverage.
- Liaise with insurers, brokers, clients, international TPA partners, and internal departments on policy administration.
- Coordinate policy updates, membership activation, and eligibility-related requirements.
- Investigate and resolve policy administration issues, escalating complex cases when necessary.
- Perform regular reconciliation of membership and policy data between insurers, internal systems, and TPA partners.
- Identify and resolve discrepancies, duplicate records, and missing information to ensure data accuracy and consistency.
- Maintain accurate and up-to-date policy and membership databases.
- Prepare periodic reports on active policies, membership movements, endorsements, and pending requests.
- Monitor processing accuracy and turnaround times, identifying opportunities for operational improvement.
- Support process automation, system enhancements, and data quality initiatives.
Skills and Competencies
- Bachelor’s degree in business administration, Insurance, Healthcare Administration, or a related field.
- Advanced Microsoft Excel proficiency is mandatory, including XLOOKUP/VLOOKUP, PivotTables, complex formulas, data validation, and reconciliation of large datasets.
- Strong analytical skills with the ability to identify discrepancies, investigate data inconsistencies, and ensure accuracy.
- Excellent attention to detail, organizational skills, and time management.
- Understanding of health insurance policy administration, membership management, and benefit structures.
- Ability to manage large volumes of data and multiple tasks while meeting strict deadlines.
- Excellent written and verbal communication and stakeholder coordination skills.
- Ability to work independently, take ownership of assigned responsibilities, and proactively resolve issues.
- High standards of confidentiality, compliance, and data integrity.
Qualifications and Experience
- Minimum 5 years’ experience in health insurance policy management is mandatory.
- Proven experience in policy setup, membership administration, endorsements, renewals, and benefit configuration.
- Experience handling large corporate medical insurance policies and complex membership databases.
- Previous experience working with a health insurance company or Third-Party Administrator (TPA) is preferred.
Important: This position requires an experienced, technically proficient professional capable of independently managing complex policy administration activities. Candidates must possess strong Excel and data management skills, with a minimum of five years of relevant experience.
interested candidates are invited to send their CVs to [email protected]
