Current Jobs at Health Solutions Africa

Role Purpose    

To effectively contribute towards various Teams, ensuring that key performance indicators and service level agreements are met.

Requirements    

• A National Senior Certificate is essential (Mathematics / Mathematical Literacy as a Grade 12 subject is highly advantageous)
• MS Office / 365 proficiency is essential
• At least 1 years’ experience in an administrative environment is essential
• Exposure to a medical scheme administrative environment would be highly advantageous

Duties & Responsibilities    

• Accurate scanning and recording of electronic and paper claims/documents in relevant folders according to process.
• Build and maintain relationships with internal and external stakeholders by responding to queries (correspondence and face-to-face).
• Assist with other functions in the team and organisation as required.
• Provide clients with relevant information and documentation as required in line with policy guidelines.
• Capture and update client information on relevant system/s, based on data received.
• Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

Competencies    

• Accountability
• Time management
• Attention to detail
• Teamwork and cooperation
• Verbal and written communication
• Service orientation
• Problem solving
• Detail-oriented
• Prioritisation

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Role Purpose    

Assess, review and manage living benefit claims, in accordance with relevant legislation and company policy, adhering to service level agreements and meeting client and business expectations.

Requirements    

• Grade 12 or equivalent qualification.
• Minimum of 1-2 years’ experience in processing claims.
• Experience in the assessing of relevant insurance or medical aid claims, paper and/or EDI (desirable).
• Knowledge of relevant legislation and industry regulations.
• Knowledge of the claims assessment process (paper and EDI).
• Knowledge of the relevant scheme or product rules.
• Knowledge of relevant claims operating systems and tools.

Duties & Responsibilities    

• Assess, review and manage disability, dread disease and income disability claims and any other claims that need a medical assessment component in line with service level agreements.
• Partner and collaborate with relevant stakeholders, to improve claims assessment and the clients claim experience.
• Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement.
• Keep accurate records of all claims assessed in accordance with business expectations and relevant legislation.
• Keep abreast of relevant regulatory frameworks, insurance related court decisions and/or determinations by regulatory bodies, governing bodies etc. that could impact the way claims are processed or handled.
• Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
• Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.
• Give input into and review claims policies, practices, forms and documentation to ensure that risk management standards are met and aligned to relevant product changes and legislative updates.
• Provide accurate and timeous reporting, analysis and insights on claims assessed as and when required. 
• Provide authoritative expertise to clients and stakeholders.
• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
• Develop and maintain productive and collaborative working relationships with peers and stakeholder.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas.
• Take ownership for driving career development. 
• Contribute to the financial planning process within area.
• Identify opportunities to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

Competencies    

• Examining Information
• Documenting Facts
• Interpreting Data
• Interacting with People
• Making Decisions
• Meeting Timescales
• Managing Tasks
• Communication skills
• Service orientation
• Prioritisation skills
• Analytical skills.
• Attention to detail.
• Interpersonal skills.
• Problem solving skills.

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Role Purpose    

To investigate, analyse, resolve and advise on support issues in a business application support environment.

Requirements    

• Matric.
• 3 Years tertiary qualification (IT degree/ diploma).
• Minimum 2 years Support Analyst or Senior Application Support experience.
• Basic knowledge of disciplines in an Application Support environment, incident handling, change management, problem management and related areas.

Duties & Responsibilities    

Operations and Maintenance

• Participation in complete life cycle of support issues from call logging, investigation, recreation, resolution, workarounds and liaison with the client regarding delivery of fixes.
• Addressing advanced customer business and technical queries.
• Assist with providing and implementing temporary workarounds.
• Review and improve operational requirements relating to the business processes.
• Coordinate and manage maintenance requests between the Business and IT.
• Ensure that request, are timeously resolved.
• Ensure that all the documentation exists and that sign-off is obtained on all system releases (SAS 70 requirements).
• Align business processes.
• Ensure that system requests accommodate all information and detail required in order for IT to affect the request as timeously and correctly as possible.
• Analysis of system requests at all times in order to identify inefficient business process, training requirements and system enhancements.
• Recommend developments on Business Processes with the view on maximising efficiency and minimising administrative costs.
• Ensure that regular interaction and exchange of information is achieved between IT and the business.
• Ensure proper system/test documentation and safe keeping thereof.
• Knowledge transfer to business partners and technical support on daily basis.

Business and System Analysis

• Collaborate with business stakeholders and development teams through joint problem solving sessions to ensure that solutions are robust, correctly monitored, prioritized and lifecycle resilient.
• Drive the process of optimizing current solutions through a service improvement approach to ensure return on investment and that service levels for all deliverables are met.
• Provide specialised investigation and analysis of data integrity between source and destination applications.
• Follow up and provide feedback to the customer for escalated application issues.
• Ensure that verbal and written reports of application investigations and resolutions are accurate and clear before presentation to the customer.
• Extract and analyse application and system support data.
• Understanding clients business processes and requirements.
• Propose and make configuration amendments.
• Attend and provide input into weekly, monthly and adhoc customer support meetings.
• Advise and train support teams with investigations and support processes.
• Participate in performance measurement of support team members.
• Be available to Shift and Standby personnel for significant events.
• Participate in the customer management escalation standby schedule.
• Identify inefficient business and or system processes.
• Analyse and identify business processes identified as inefficient.
• Proposing and ensure implementation of new or enhanced business and or system processes.
• Analysing of Bugs, identifying system improvements and or enhancements to increase productivity and decrease costs and ensure implementation of changes.
• Ensuring that system changes are at all times catering for ongoing business changes and requirements.
• Ensuring that redundant system processes are removed.

Competencies    

• Problem solving exposure at application and business transaction level using application log files and SQL database queries.
• Commitment to performing routine as well as investigation/analysis work tasks.
• Ability to solve medium complexity problems.
• Understand and develop the support team technical competency.
• Self-motivated, proactive, taking ownership of problems until they are resolved.
• Mature person with the sense of responsibility to do after hours standby.
• Good oral and written communication skills.
• Good customer relationship skills.
• Quick learner (short initial ramp up period).
• Must be comfortable with working in the customer domain.
• Results Driven.
• Collaboration and Strategic Thinking.

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Role Purpose    

Ensure accurate and compliant underwriting decisions through thorough investigation, alignment with guidelines, analysis of underwriting criteria, and maintaining quality and compliance standards.

Requirements    

• Bachelor degree or equivalent qualification in a relevant field such as healthcare administration, nursing, allied sciences, or equivalent medical-related discipline is essential 
• Underwriting Certification
• Registered with the Health Professions Council of South Africa (HPCSA) or the South African Nursing Council (SANC)
• 2 - 3 years practical experience in Clinical Health Risk Management and or equivalent relevant experience
• Health underwriting and familiarity with non-disclosure processes, principles, and terminology
• Experience in the Financial/Insurance industry 

Duties & Responsibilities    

PROCESS

• Conduct thorough medical assessments and apply clinical knowledge in a professional manner, ensuring accuracy and precision.
• Provide expert advice and support in underwriting, non-disclosure, and claims for moderate and complex assessments, effectively mitigating organisational risk.
• Make precise non-disclosure decisions for beneficiaries and dependents who fail to disclose health conditions upon re-joining the medical aid, adhering to the Medical Scheme Act, underwriting policy, and established standards, protocols, and guidelines.
• Implement condition-specific waiting periods following non-disclosure investigations.
• Investigate client queries within agreed service levels, delivering timely feedback to ensure utmost client satisfaction.
• Review claims and authorization history to identify any additional non-disclosed health conditions, enhancing accuracy in underwriting decisions.
• Develop and maintain productive relationships with peers and stakeholders, fostering collaboration and effective communication.
• Establish and uphold underwriting policies and guidelines, ensuring consistency, defensibility, and adherence to industry standards.
• Manage non-disclosure escalations within specified turnaround times, resolving issues promptly and efficiently.
• Foster positive relationships and partnerships with clients and key stakeholders, promoting trust and mutual growth.
• Efficiently plan, administer, and process beneficiaries' health information in alignment with performance objectives, ensuring data integrity and compliance.
• Collaborate with stakeholders in conducting underwriting and medical research in targeted areas, facilitating informed decision-making.
• Interact with clients competently and professionally, maintaining high-quality standards and delivering exceptional service.

CLIENT

• Establish and nurture relationships with clients, internal teams, and external stakeholders, fostering strong connections and mutual trust.
• Meet and exceed service level agreements applicable to clients and stakeholders, effectively managing and surpassing client expectations.
• Provide recommendations to enhance client service and ensure fair treatment within the realm of responsibility, promoting satisfaction and loyalty.
• Monitor turnaround times and quality standards, proactively resolving issues to enhance client service delivery.
• Provide accurate and timely resolution of client queries, utilising feedback to drive process improvements and optimise client service.

PEOPLE

• Build strong relationships, share specialised knowledge, and demonstrate effective leadership, fostering collaboration and positive engagement.
• Continuously develop industry expertise and relevant knowledge, applying acquired insights to drive excellence.
• Positively influence and manage change, offering support and guidance when required, fostering adaptability and resilience.
• Foster a culture of innovation by involving colleagues and staff in the development and implementation of new ideas, driving continuous improvement.
• Contribute to work-centric thinking, productivity, service delivery, and quality management, promoting a high-performance work environment.
• Take ownership of driving career development, proactively pursuing growth opportunities and self-improvement.

FINANCE

• Implement and provide input into governance processes, systems, and legislation in the specialised area, ensuring compliance and efficiency.
• Escalate unresolved policy and governance compliance issues for investigation and resolution, promoting accountability and risk mitigation.
• Contribute to risk identification processes and communicate recommendations in the appropriate forum, enabling proactive risk management and mitigation.

Competencies    

• Examining Information
• Interacting with People
• Meeting Timescales
• Documenting Facts
• Articulating Information
• Upholding Standards
• Interpreting Data
• Making Decisions