Risk Coordinator at Wilderness

Job Purpose

• To provide strategic relationship and scheme management for Restricted Membership Medical Schemes under Discovery Health’s administration. The role entails the ownership, facilitation and oversight of a number of smaller and less complex restricted schemes’ regulatory, legislative, governance and compliance requirements, risk management requirements, managed care requirements, administration requirements, including but not limited to servicing, systems, website and mobile app development, implementation and management of service level agreements and contracts, ensuring SLA adherence, general administration, communication and marketing requirements, underpinned by exceptional relationship management and solving for schemes’ complex needs.

Key Outputs

LEGAL, GOVERNANCE & COMPLIANCE

• To ensure that the schemes managed have governance structures in place and to ensure that these structures are applied and adhered to.
• Compliance with all requirements in terms of the schemes’ annual regulatory calendar.
• Liaise with the Regulator regarding key scheme deliverables and communications.
• Drafting, updating, and managing various administrative, managed care and other contracts (including third party contracts).
• Ensure that the contracting process is correctly applied and administered and that all contracts are updated as required.
• Drafting, implementing, and monitoring all schemes’ policies, mandates, and resolutions.
• Drafting and updating schemes’ rules as required by law. Engaging the Council for Medical Schemes and its Regulator regarding the approval of rule amendments.
• Ensure effective and accurate implementation of all scheme rules and rule amendments across the business as and when required.
• Responsible for oversight of regulatory change management and guidance on compliance impact on the various schemes.
• Manage and oversee significant regulatory projects.
• Provide strategic guidance in decision-making on compliance or regulatory matters.
• Ensure overall adherence with Service Level Agreements.

RISK MANAGEMENT

• Identify new risks and monitor existing risks through review and analysis of risk incidents, key risk indicator breaches, assurance provider findings, outcomes of special reviews, etc.
• Assist with compiling risk registers for all areas, ensure significant risks are escalated to appropriate people and reflected in registers, and monitor the efficacy of controls.
• Support and manage the SRM team in respect of alignment with scheme strategies and ensuring reporting of scheme key cost and utilisation drivers in the SRM environment (including development and presentation of creative proposals to address such issues).
• Work within a shared value approach to ensure approved projects' successful development and implementation.

STRATEGY, RELATIONSHIP MANAGEMENT & STRATEGIC REPORTING

• To assist in developing and implementing the schemes’ growth strategy, brand strategy, partnerships and the interface with unions, employers, and employees, where relevant.
• Assistance in preparing the strategy, costing of benefits and impact analysis of proposed changes.
• Review current processes and rules of the Scheme to ensure that practice follows reported information and assess improvement opportunities.
• Liaison between different parts of the business to ensure overall implementation of Scheme strategies and decisions.
• Sustainable client relationship with the schemes and all its management structures.
• Negotiate, consult, influence, and build relationships with key internal departments and external organisations from time to time, such as professional bodies, marketing agencies, and research organisations.
• Assist in coordinating and communicating key strategic risk management initiatives and outcomes at the various meetings of Boards of Trustees. 
• Coordinating the correct outcome of contracts in design and implementation.
• Assist with the take-on process of new schemes and maintaining client relationships.
• Attend all scheme board and subcommittee meetings as required.

FINANCE & AUDITS

• Liaison with Auditors (internal and external) regarding various audits agreed throughout the year.

OPERATIONS

• Liaison with departments to ensure query resolution and collating of information to be passed on to the respective Boards and/or Subcommittees of the Boards.
• Liaise with clinical staff and the clinical risk department with respect to delivering the schemes’ expectations of our schemes.
• Plan, lead, organise and control the activities of the administrator to deliver on Scheme requirements.
• Liaise with staff across the business regarding queries.
• When necessary, liaise with the claims department regarding payment of claims.
• Attend all client operational meetings.
• Manage and oversee significant scheme projects.
• Ensure benefit and contribution changes are implemented annually across the business, including marketing, training, service teams, etc.

MARKETING & COMMUNICATIONS

• Ensuring the schemes’ interests and brand needs are met and sustained within Discovery.
• To support Marketing Services in the design and development of the schemes’ marketing material, including material regarding their year-end processes/launches, Annual General Meetings, and all other member, employer, and provider communication.
• To support schemes and Marketing Services in developing and designing below-the-line and above-the-line advertising strategies and campaigns.
• Support Marketing Services in ensuring the schemes’ website design and content remains updated.
• Support Marketing Services in ensuring the schemes’ mobile app design and content remains updated.

SYSTEM DEVELOPMENT & REPORTING

• Oversee the development of, and initiate requirements for new reporting and PowerBI (or other) dashboards and templates for scheme reporting.
• Identify opportunities to improve and automate reporting.
• Proactively identify trends and perform other data analyses.
• Ad-hoc reporting requirements as requested by schemes.
• Oversee the preparation of Board and Sub-committee reports.
• Assume responsibility for reporting on Fraud Waste & Abuse at various Boards or Sub-committees of the Board.
• Compile or arrange for the compilation of reports for Board meetings and/or according to schemes’ needs.
• Ensure development of schemes’ websites.
• Ensure development of schemes’ mobile app.
• Ensure implementation of benefit and contribution changes annually across the various systems, including claims, administration, communication, digital tools and internal reference tools, etc.
• Ensure schemes updated about new trends systems and services such as machine learning tools and AI and ensure ongoing implementation of these tools as and when required.
• Liaise with the Business Intelligence department for the necessary reports required.
• May be required to take responsibility for specialised reporting such as IT Security and IT Governance reporting.

DISCOVERY REPRESENTATION

• Ensuring the Discovery profitability, strategic imperatives and operational interests are protected, and targets are met in terms of fee structuring and new scheme initiatives.
• Represent the Discovery position on key issues at relevant forums/schemes.
• Where required, responsible for relationships and communication between the various Discovery subsidiaries.\
• Ensuring colleagues and other work streams consider the needs of the schemes when developing new products, processes, communication, and structures, etc.

STAFF MANAGEMENT

• Management of Fund Associates and Fund Coordinators.
• Upskilling and developing Fund Associate or Fund Coordinator.
• Recruitment of new Fund Associate or Fund Coordinator, where required.
• Ongoing review and assessment of performance relative to KPIs.
• Maximise work efficiency and productivity.
• Firm and consistent approach to ongoing performance measurement and management of Fund Associate or Fund Coordinator.
• Resolution of all IR issues in conjunction with HRM.
• Coaching and mentoring of Fund Associate or Fund Coordinator to achieve client objectives.
• Development and training in respect of succession planning.
• Drive training interventions to close skills gaps.
• Mentoring and coaching of staff.
• Creating and maintaining a positive work environment for your Fund Associate or Fund Coordinator, ensuring we meet client requests and needs and acknowledge a job well done.
• Encourage and motivate your Fund Associate or Fund Coordinator to resolve issues, accomplish goals and influence their career mobility

Skills and Education required

• Bachelor’s Degree OR a minimum of 24 months of medical scheme industry experience.
• 5-7 years of Fund Management experience.
• 5 years of leadership in the corporate environment
• 2-3 years of clinical experience is advantageous (advantageous)
• 2-3 years of compliance/legal /finance experience (advantageous)
• Matric
• Bachelor’s degree
• Finance Qualification (Advantageous)
• Legal Qualification (Advantageous)
• Clinical Qualification (Advantageous)