Operational Analyst - Electronic Transaction Management (ETM) at Discovery Limited

Key Purpose

The role is responsible for the testing and communication to third parties of any changes as a result of scheme take-ons or key initiatives and ongoing maintenance that would impact electronic claim submission codes.  Enabling third party integrations related to electronic claims and authorisations and involves managing relationships, testing and facilitating query and defect resolution during the integration.

Key outputs

• The successful applicant will be responsible for but not limited to the following job functions:
• Areas of responsibility may include but not limited to
• Completion of DCR's allocated from issues logged and projects from the go live schedule.
• Management of Operational Reports, test and investigate all related issues and provide feedback on these issues to the relevant stakeholders.
• Build and maintain relationships with all Trading Partners.
• Facilitate and arrange meetings between Discovery Health and Trading partners.
• Distribute tariffs and changes to tariffs to all Trading Partners where applicable.
• To ensure that Service level agreements are met at all times with Internal and External clients.
• Reviewing test scenarios for comprehensiveness and executing testing of changes and new requirements.
• Handover and training of new implementations and integrations with the query analystst.
• Project managing all integrations and key initiatives from an ETM perspective to ensure timelines are met.

Personal Attributes and Skills

• The successful candidate would need to have the following competencies:
• Makes prompt, clear decisions, which may involve tough choices or considered risks. Takes responsibility for actions, projects and people. Takes initiative, acts with confidence and works under own direction. Initiates and generates activity.
• Upholds ethics and values. Demonstrates integrity. Promotes and defends equal opportunities, builds diverse teams. Encourages organisational and individual responsibility towards the community and the environment.
• Establishes good relationships with customers and staff. Builds wide and effective networks of contacts inside and outside the organisation. Relates well to people at all levels.
• Makes a strong personal impression on others. Gains clear agreement and commitment from others by persuading, convincing and negotiating. Promotes ideas on behalf of self or others. Manages conflict. Makes effective use of political processes to influence and persuade others.
• Applies specialist and detailed technical expertise. Develops job knowledge and expertise through continual professional development. Shares expertise and knowledge with others. Uses technology to achieve work objectives. Demonstrates appropriate physical co-ordination and endurance, manual skill, spatial awareness, and dexterity. Demonstrates an understanding of different organisational departments and functions.
• Analyses numerical data, verbal data and all other sources of information. Breaks information into component parts, patterns and relationships. Probes for further information or greater understanding of a problem.  Makes rational judgments from the available information and analysis. Produces workable solutions to a range of problems. Demonstrates an understanding of how one issue may be a part of a much larger system.
• Focuses on customer needs and satisfaction. Sets high standards for quality and quantity. Monitors and maintains quality and productivity. Works in a systematic, methodical and orderly way. Consistently achieves project goals.
• Adapts to changing circumstances. Accepts new ideas and change initiatives. Adapts interpersonal style to suit different people or situations. Shows respect and sensitivity towards cultural and religious differences. Deals with ambiguity, making positive use of the opportunities it presents.
• Writes clearly, succinctly and correctly. Writes convincingly in an engaging and expressive manner. Avoids the unnecessary use of jargon or complicated language. Writes in a well-structured and logical way. Structures information to meet the needs and understanding of the intended audience.

Education and Experience

The following requirements are Essential:

• Matric
• Relevant tertiary qualification - advantageous
• At least 5 Years Medical Scheme Claims experience
• Thorough knowledge of Discovery Health product, systems, and process - advantageous
• Ability to accurately document system requirements
• System development and project management life cycle experience including end to end testing
• Computer literacy level required:
• Windows
• Excel at an intermediate level
• Word
• Outlook