Job Opportunities at Discovery Limited

Areas Of Responsibility May Include But Not Limited To

The successful candidate will be required to perform but not limited to the following key outputs in respect of the DHS Care and Claims portfolio:

• Analysis, investigation and reporting of presented problem
• Ability to identify interim and long term solutions
• Produce specification for the proposed solution
• Read and interpret specifications
• Create and execute test cases
• Develop and maintain Developer, Business Analyst and Business interaction / relationships at team and management level
• Data and trend analysis
• Impact Assessment and prioritization
• Process Mapping, evaluation and improvement

Competencies

The Successful Candidate Must Demonstrate The Following Competencies

• Politically astute
• Self-motivated, self-starter
• Team player
• Continuous learning drive
• Confident
• Analytical and logical thinker, problem solving
• Strong communication skills
• Strong attention to detail

Education And Experience

• Relevant 3-year degree or equivalent 3 year qualification
• Minimum of 3 years working experience in dealing with Claims processing systems and operational requirements.
• Strong understanding of Discovery Health Claims domain
• PL/SQL – writing/running queries (added advantage)
• Experience in Health Care industry
• MS Office Suite
• Advanced Excel
• Working experience in an ITIL based environment (added advantage)

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Key Outputs

The successful applicant will be responsible for but not limited to the following job functions:

• Assessing the case in relation to the following:
• Members clinical history
• Members benefit structure
• Clinical Information and coding supplied
• Level of care provided
• Appropriateness of the facility
• Appropriateness of the treating doctor
• Appropriateness of treatment
• Managing the benefit for the member and the risk for the relevant scheme through a thorough process to approve or decline Funding to ensure that the member gets the appropriate level of care
• Discharge planning by providing the member with alternatives to receive treatment ( This includes Hospital @ Home, Homecare etc.)
• Effective and accurate communication to all stakeholders:
• Case update to the provider
• Funding decisions and benefit confirmation to the members
• Request for additional information from the treating doctor or practice manager
• Engaging with Patient Services Manager and hospital staff
• Handling escalations from Providers and internal stakeholders
• Preparing and presenting complex case to clinical review
• Trend Analysis of inefficiencies and proposals to correct
• Appropriate internal case referrals for clinical management
• Operational Targets:
• Attend to patients on daily report
• Review a minimum of 50% of daily low acuity admission requests
• Quality of processes
• Onsite perception survey

Personal Attributes

• Emotional Intelligence - Ability to understand, use, and manage emotions in positive ways to communicate effectively, empathise with others and defuse conflict.
• Composure - Is cool under pressure; does not become defensive or irritated when times are tough; is considered mature; can be counted on to hold things together during tough times; can handle stress; is not knocked off balance by the unexpected; doesn't show frustration when resisted or blocked; is a settling influence in a crisis.
• Conflict Management - Steps up to conflicts, seeing them as opportunities; reads situations quickly; good at focused listening; can hammer out tough agreements and settle disputes equitably; can find common ground and get cooperation with minimum noise.
• Decision Quality – Makes good decisions (without considering how much time it takes) based upon a mixture of analysis, wisdom, experience, and judgment; most of his/her solutions and suggestions turn out to be correct and accurate when judged over time; sought out by others for advice and solutions.
• Integrity and Trust - Is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn't misrepresent him/herself for personal gain.
• Negotiating - Can negotiate skillfully in tough situations with both internal and external groups; can settle differences with minimum noise; can win concessions without damaging relationships; can be both direct and forceful as well as diplomatic; gains trust quickly of other parties to the negotiations; has a good sense of timing.
• Perseverance - Pursues everything with energy, drive, and a need to finish; seldom gives up before finishing, especially in the face of resistance or setbacks.
• Problem Solving - Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.

The Following Requirements Are Essential

Education and Experience:

• Matric
• Must be a Registered Nurse
• Valid SANC Registration
• 3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable)
• 2 years Managed health care experience
• Microsoft Office (Specifically Excel experience)
• Valid Driver’s License and own transport
• Effective Communication Skills (Verbal & Written)
• Telephone Etiquette
• Active Listening Skills

The Following Requirements Will Be Advantageous

• 1 – 2 years ICU experience.
• Knowledge of DH SOP’s and Process experience (internal only)
• Provider payment arrangements (internal Only)
• Clinical coding knowledge of ICD-10 and/or CCSA

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Where you would add value

• Is a servant-leader for the Scrum Team that does anything possible to help the team perform at their highest level
• Help form a self-managed team that is motivated, predictable, transparent and consistently delivers quality work and continually inspects and adapts in order to improve and maximize throughput whilst upholding the Agile values, principles and practices
• Facilitates the removal of impediments teams face when developing solutions
• Implements agile best practices within a team
• Helps the development team, business and management develop a culture of collaboration - Act as a change agent to the team and organisation
• Supports the team to be self-organising and function as an accountable, high performance team
• Focused and goal driven and helps to achieve the Sprint goals
• Be a master facilitator

How You Would Make a Difference

• Act as Scrum master for 2 – 4 scrum teams with a focus on guiding the teams towards improving the way they work.
• Facilitate Scrum Events ensure that they are focused and productive (Daily Stand-ups, Sprint Planning, Sprint Reviews, Retrospectives and Backlog Grooming)
• Help facilitate Product Planning Workshops and Release Planning Sessions
• Assist the Product Owner in prioritisation and scheduling of work, to meet delivery time frames
• Ensure backlog is in good standing by having regular re-occurring weekly backlog grooming sessions
• Ensure that all the team members understand their role and fulfil them to the best of their ability
• Guide/coach/mentor the development team to take on the responsibilities of the process and ownership of the product – lead the team to a self-organised state
• Build a high performing team, focusing on improving team dynamics and performance, help the team manage interpersonal conflicts, challenges and opportunities for growth.
• Protect the team from interruptions and distractions to maximize productivity and create flow of work
• Identify and facilitate the resolution of identified impediments
• Help the team make achievable sprint commitments with the use of velocity data and team availability
• Help the team members communicate, co-ordinate and meet their delivery goals
• Ensure the team / stakeholders adhere to Definition of Ready (DoR) / Definition of Done (DoD)
• Highlight risks and dysfunctions where the DoR / DoD is not met
• Ensure the team uses the standardized reference story for estimating
• Ensure understanding of the Agile principles and Scrum process, across teams and stakeholders
• Ensure adherence to the Agile principles and Scrum process and help resolve any deviations
• Raise issues that are putting delivery at risk as soon as they arise
• Help facilitate delivery solutions and manage expectations
• Responsible to produce the following artefacts (Weekly Sprint Reports, Release projection / Burndown) to create visibility and transparency of the progress and status of the systems delivery
• Continually grow and share Agile knowledge.

Education

What you need to be successful

• Matric
• Certified scrum master/scrum practitioner
• Tertiary degree (B. Engineer, B.Com, BSC) advantageous

Experience

• At least 2-4 years’ experience working in a Scrum Master role
• At least 2 years’ experience working in an agile environment, preferably in a variety of situations
• Experience working within Scaled Agile Framework (SAFe) advantageous

Behavioral Skills

• Stress Management
• Time management and prioritization
• Learning orientation
• Innovation
• Bias for action
• Teamwork and co-operation
• Strong management skills

Technical Skills

• Knowledge and/or experience of Kanban, Agile, Scrum Framework
• Knowledge of the software development life cycle and concepts such as TDD, XP, etc
• Essential you are fully proficient at Jira administration, for example:
• Understand the JIRA data model
• Create and maintain workflows, transitions, post actions, etc.
• Plugin evaluation
• Project administration
• Create and maintain Users and Security Groups
• Proficient in writing JQL queries
• Create and maintain fields and field configurations, screens and screen configurations
• Excellent communication skills in English in written and spoken form
• Working with ServiceNow IT Business Management (ITBM) advantageous

Other

• Overtime may be required from time to time