TRYPHINE ZULU
Johannesburg
Summary
Dynamic individual with hands-on experience in managed care and a talent for navigating challenges in health insurance. Brings strong problem-solving skills and proactive approach to claims risk containment. Effective leader dedicated to implementing innovative strategies for provider reimbursement and clinical risk management for sustainable health insurance. Proactive and goal-oriented professional known for reliability and adaptability, with swift capacity to learn and apply new skills.
Overview
16
16
years of professional experience
Work History
Chief Healthcare Officer
Platinum Health Medical Scheme
08.2022 - Current
- Executive responsible for: Group Pharmacy Operations, Allied Healthcare Services, Dental Healthcare services, Managed Care Operations and Strategy, Clinical and Claims Risk Management, Actuarial Reporting
- Project Owner and lead for the implementation of a new electronic health records system
- Streamlined administrative processes to reduce wait times by 26% and improve overall patient satisfaction.
- Reduced dental costs by 45% through reducing external referrals to orthodontists
- Successfully navigated complex regulatory requirements for managed care certification to ensure compliance with all relevant laws and achieved certification within 6 months.
- Negotiated tariffs and service levels with hospital groups and specialists to decrease expenses and improve reserves
Senior Manager Clinical Risk and Medicine Management
Government Employees Medical Scheme (GEMS)
03.2019 - 07.2022
- Responsible for the scheme's oversight of all managed care processes and contracts including hospital benefit management, chronic disease management pharmaceutical benefits management, and claims risk management initiatives.
- Evaluated vendor offerings critically to select the most appropriate partners for delivering desired results at optimal costs.
- Leveraged data and analytics to make informed decisions and drive business improvements to reduce the cost of pharmaceutical benefits on high volume drugs resulting in a saving of R100m per annum.
Advanced Clinical Risk Specialist
Medscheme Holdings
01.2017 - 02.2019
- Provided strategic direction to the actuarial team regarding claims data analytics
- Introduced novel ways of assessing claims risk to manage inappropriate utilization of hospital benefits leading to a 30% improvement in claims expenditure
- Improved turnaround times on reporting to the scheme on hospital benefits utilization and claims risk controls to weekly Dashboards to the CEO
National Health Insurance Technical Consultant
National Dept. of Health
12.2015 - 12.2016
- Coordinated the work-streams responsible for drafting the National Health Insurance White Paper
- Participated in industry conferences, workshops, and seminars for professional associations to promote National Health Insurance White paper.
- Presented monthly progress reports to the Director General for the Ministry of Health
Technical Consultant
National Treasury
03.2015 - 11.2015
- Facilitated knowledge transfer among team members by leading training sessions on new tools and techniques relevant to Health Portfolio budget allocation.
- Developed a new Budget Allocation model for equity-based resource allocation.
- Presented findings and recommendations to the Chief Director through clear visualizations, reports, and presentations that facilitated informed budgeting process.
Health Financing Analyst
Clinton Health Access Initiative (CHAI)
09.2014 - 02.2015
- Collaborated with cross-functional teams to identify opportunities for report improvement and increased efficiency.
- Improved internal knowledge sharing by developing comprehensive documentation outlining methodological best practice for Health Economics analyses
- Streamlined reporting procedures by creating user-friendly dashboards for easy access to key performance indicators.
Pharmacist
Chris Hani Baragwanath Hosp.
10.2008 - 10.2012
- Managed high volume of prescriptions daily while maintaining excellent customer service and attention to detail.
- Developed strong relationships with healthcare providers to optimize patient care and medication adherence by joining the hospital's Therapeutics Committee.
- Mentored and trained new pharmacists and pharmacy technicians, fostering a supportive work environment focused on professional growth.
- Assisted in the development of policies and procedures related to the Oncology pharmacy operations, promoting compliance with legal regulations and best practices.
Education
MSc Actuarial Science and Data Analytics - Actuarial Science
University of Leicester
United Kingdom01.2024
Ph.D. - Health Economics
University of Cape Town
Cape Town03.2020
Master of Science - Public Health
University of Cape Town
Cape Town12.2014
MMed Pharmacotherapy - Pharmacy
Witwatersrand University
Johannesburg, South Africa01.2012
Bachelor of Science - Pharmacy
University of Zimbabwe
Harare, Zimbabwe06.2005
Skills
- IBNR Calculations
- Health Insurance Benefits design
- Budgeting and financial management
- Business Development
- Contract Negotiation
- Pricing strategy
- Expertise in R, SQL, Excel and Stata
- Claims Risk Management
- Underwriting principles
- Provider Reimbursement
- Data Modeling
- Student Actuary
Timeline
Chief Healthcare Officer
Platinum Health Medical Scheme
08.2022 - Current
Senior Manager Clinical Risk and Medicine Management
Government Employees Medical Scheme (GEMS)
03.2019 - 07.2022
Advanced Clinical Risk Specialist
Medscheme Holdings
01.2017 - 02.2019
National Health Insurance Technical Consultant
National Dept. of Health
12.2015 - 12.2016
Technical Consultant
National Treasury
03.2015 - 11.2015
Health Financing Analyst
Clinton Health Access Initiative (CHAI)
09.2014 - 02.2015
Pharmacist
Chris Hani Baragwanath Hosp.
10.2008 - 10.2012
MSc Actuarial Science and Data Analytics - Actuarial Science
University of Leicester
Ph.D. - Health Economics
University of Cape Town
Master of Science - Public Health
University of Cape Town
MMed Pharmacotherapy - Pharmacy
Witwatersrand University
Bachelor of Science - Pharmacy
University of Zimbabwe
Publications/Presentations
- Speaker at the Board of Healthcare Funders Annual Conference, 2024
- Facilitator for two sessions at the International Health Economics Association (iHEA) Congress. Cape Town, 2023
- Two oral presentations at the International Health Economics Association (iHEA) Congress. Basel, Switzerland, 2019
- Zulu T, Heap M, Sinanovic E The cost and utilisation patterns of a pilot sign language interpreter service for primary health care services in South Africa. PLoS ONE 12(12): e0189983. https://doi.org/10.1371/journal.pone.0189983, 2017
- Ncube-Zulu T & Danckwerts MP. Comparative hospitalization cost and length of stay between patients with and without diabetes in a large tertiary hospital in Johannesburg, South Africa. International Journal of Diabetes in Developing Countries, 34 (3) 156-162, 2013
Advisorycommittees
- World Health Organization (WHO), Member of the Advisory Group on the Governance of the Private Sector for Universal Health Coverage, 2019, Present
- National Department of Health (South Africa), Ministerial Expert Review committee member on Primary Health Care and Hospital Level Essential Medicines List, 2019, 2022
- National Department of Health (South Africa), Medicine Pricing Committee, 2020, 2023
- Metrics4Management, Board member
Awards
Awarded the National Department of Health/Public Health Enhancement Fund National Health Scholars Scholarship to complete my MPH at the University of Cape Town
References
Prof Dominic Montagu
Board Chairperson Metrics4Managemnt
University of California-San Francisco
Email: dominic.montagu@ucsf.edu
Prof Paul King
Personal Tutor and Course Director
University of Leicester
Email: paul.king@leicester.ac.uk
Mr. Simba Mareverwa
Consulting Actuary and Business Development Manager
Insight Consulting Actuaries
Email: masimbam@insight.co.za
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