Senior Medical Scheme Manager
hace 5 días
Sutton
Support elite performance with exceptional care. The Health Partners Europe Group (HPE, Sempris and Formis) operate at the heart of elite and professional sport across the UK. For over thirty years, Health Partners has developed and maintained a comprehensive, unified ecosystem covering healthcare, performance and risk governance. Through three closely aligned businesses, we coordinate care for professional athletes across football, rugby, cricket, and over 75 sporting disciplines (Health Partners), alongside the provision of specialist indemnity insurance for sports medics (Sempris) and the data driven performance management of elite athletes (FORMIS). Our clients include Premier League Football Clubs, National Governing Bodies, National squads, academy, youth and disability players. We facilitate the medical care of more than 97% of all professional football players across the 92 clubs in the Premier League and English Football League. We are trusted by some of the largest sporting organisations in the world for our discretion, governance, and ability to build and maintain complex healthcare systems. The group continues to grow and we are looking for an experienced, strategic, and commercially grounded individual to join us as our Senior Medical Scheme Manager. Role Overview This is a senior role with strategic and holistic oversight of key medical schemes and healthcare trusts. It requires a seasoned professional who brings 10–15 years of experience in insurance, healthcare scheme management, trust administration, or a comparable environment. You will be responsible for the performance, governance, financial integrity, and development of one or more major schemes. This includes data analysis, reporting to boards and trustees, contribution and rate-setting, and the continuous improvement of scheme processes and systems. You will work closely with senior clinicians, NGBs, administrators, and specialist healthcare providers. The role suits someone who is comfortable switching between high-level strategic thinking and detailed operational oversight, who can bring clarity, structure, and considered judgement to complex schemes. Key Responsibilities Strategic Scheme Management & Governance • Provide overarching leadership and direction for assigned schemes, ensuring alignment with trust objectives and governance requirements., • Lead annual renewal cycles, preparing contribution recommendations, performance summaries, and board-level presentations., • Maintain a deep understanding of scheme rules, benefits, pricing frameworks, and governance processes., • Identify emerging issues, trends, or risks and communicate them effectively to trustees, boards, or internal leadership., • Ensure scheme decisions are consistent, transparent, and aligned with policy and regulatory expectations. Financial Oversight & Performance Management • Own the end-to-end financial management of the scheme, including contribution setting, loss-ratio analysis, and forecasting., • Conduct detailed quarterly membership reconciliations and issue accurate contribution invoices to all scheme participants., • Oversee claims and benefits administration, including adjudication of discretionary requests and escalation where appropriate., • Reconcile management accounts, provider invoices, and internal claims data to ensure financial accuracy and accountability., • Monitor spend patterns, utilisation rates, and high-cost cases to support strategic decision-making. Stakeholder & Relationship Management • Act as a senior point of contact for scheme administrators, clinicians, providers, and internal teams., • Build trusted working relationships that support scheme stability, responsiveness, and good communication., • Provide clear guidance on scheme rules, eligibility, and administrative processes., • Represent the scheme in meetings with trustees, board members and partner organisations. Data, Reporting & Insight • Produce timely, accurate and strategic reporting packs, including utilisation trends, financial performance, risk insights, and scheme commentary., • Conduct deep-dive analysis to support renewal discussions, pricing decisions, and governance reviews., • Respond to ad-hoc data requests from boards, clubs, NGBs, and senior stakeholders., • Maintain and evolve scheme datasets, ensuring high data quality and clear audit trails. Systems, Processes & Continuous Improvement • Maintain accurate system configuration for scheme pricing, eligibility rules, member categories, and benefit limits., • Define and communicate system change requirements; work with developers and analysts to support improvements., • Contribute to the development of internal tools, dashboards, and reporting automation., • Support the evolution of operational processes to increase efficiency, accuracy, and user experience. Additional Responsibilities • Provide mentorship and structured oversight for colleagues working within the scheme., • Support organisational projects relating to new schemes, system upgrades, or operational redesign., • Participate in governance reviews, audits, and internal quality processes. What We’re Looking For Essential • 10–15 years’ experience in insurance, healthcare scheme management, trust administration, or PMI., • Proven ability to operate at a senior level with strategic oversight of complex schemes or portfolios., • Strong financial and analytical capability, with experience in contribution-setting, reconciliation, and scheme performance management., • Excellent communication skills, able to engage credibly with board members, trustees, and senior sport executives., • A calm, organised, and structured approach, with strong judgement and attention to detail., • Confidence managing sensitive or high-stakes issues within a governance-led framework. Desirable • Experience working with sporting organisations, healthcare providers, or regulated environments., • Advanced Excel skills or exposure to SQL or data tools., • Experience presenting insights or recommendations at board level., • Understanding of medical terminology or healthcare delivery (training can be provided). Perks & Flexibility • Exposure to senior decision-makers across elite sport and private healthcare., • Opportunity to influence and shape the evolution of major medical schemes and sit at the intersection of healthcare, risk and performance management across the elite sports landscape., • 4 days in the office across Surrey and Central London offices. 1-day WFH, • Flexible structure: 4 or 5 working days considered., • Location: Surrey, • Full MHD Private Medical Insurance, • Highly competitive pension contribution and host of other benefits, • Salary: Competitive and reflective of senior experience.
