Job Opportunities at Discovery Limited

Key Purpose:

• This position requires the successful candidate to manage legal disputes, as well as to provide legal assistance to Discovery Health when necessary.

Key Outputs

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

• Argue cases at Disputes on behalf of DHMS at weekly Dispute Hearings.
• Manage and own the entire Dispute Process and the relevant workflow pools.
• Assist senior legal advisor to respond to legal letters of demand from members.
• Provide legal assistance in respect of appeals to Council.
• Assist senior legal advisor in managing the mediation process before a matter goes on appeal.
• Provide legal training to the Benefit Compliance Review team when required.
• Update the Benefit Compliance Review team and relevant business areas on Council for Medical Schemes and dispute rulings as required.
• Monthly and quarterly trending and status reports.
• Assist in and provide advice on legal matters pertaining to Discovery Health e.g. Application of the Medical Schemes Act and Regulations to funding decisions.
• Draft heads of arguments for appeal and dispute matters.
• Investigate cases prior to going for disputes.
• Track industry trends relating to the Appeal committee and to the
• Appeal Board decisions, to assist with the implementation into Discovery Health.
• Record keeping according to company requirements

Education and Experience:

The following requirements are essential:

• Matric
• LLB qualification
• At least 1 year working experience in the medical schemes environment
• Knowledge of Managed Care Environment
• Excellent written and verbal communication skills in English
• Basic computer literacy in Microsoft Office applications (must be proficient in Excel)
• Drafting of legal documents eg. Heads of Argument, opinions and legal letters

The following requirements are advantageous:

• Knowledge of Discovery Health Medical Scheme and In-House products and protocols
• At least two years’ experience in large law firm
• Clinical /Medical knowledge

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Key Purpose

• Work closely with a passionate development team to design, develop and maintain solutions for a dynamic, multi-national company that sets the benchmark in its industry. Must be a team player and have the ability to work with both vertical and horizontal colleagues both in a formal and informal setting.

Areas of responsibility may include but not limited to:

The successful candidate will be responsible for, but not limited to, the following:

• Understanding the business requirements and through a structured process documenting, validating and translating it into Product Requirement Specifications that are used by developers to craft a technical solution.
• Testing and validating the functionality of the technical solution against the business requirements as well as providing testing support to the testing team (defect management)
• Interfacing between the business client and the development team with regards to the customer and functional requirements.
• Ensuring that the customer requirements are delivered in the implemented solution, on time and of the highest quality.
• Working with multiple business areas and multiple teams that require deep integration of solutions.
• Building and maintaining strong relationships with the business areas.
• Evaluate and measure efficiencies of business processes and provide recommendations.
• Proactively identify risk pertaining to the project. 

Education and Experience

Education

• Matric
• A Bachelor’s degree or Diploma in Computer Sciences/ Information Systems or equivalent IT tertiary qualification
• Formal Java Qualification (Advantageous)

Experience

• 4+ years’ experience in SOAP UI, SQL, PL SQL, Process Mapping and documentation
• 5+ years’ experience as a Business Analyst
• Solid testing experience.

Knowledge

• Processes: ITIL (Incident, Change, Release, Problem Management), CMMI Technologies:
• SQL, UML
• Facilitating JAD sessions, data modelling techniques, UML Process Design, Industry compliance standards and legislation Technical Skills:
• SQL Queries (essential)
• Project Management
• Business Writing Skills
• Presentation and Facilitation Skills
• Process Mapping
• Entity Diagram Mapping
• Software testing pack design and functional testing

Advantageous:

• UML Expert courses, BPMN Advanced course, IIBA certified, PM training or qualification
   

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Key outputs

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

• Confirming benefits according to set protocols and funding rules
• Accurately obtaining and capturing information to confirm correct funding
• Servicing all key stakeholders telephonically and via other servicing channels until the query has been resolved
• Servicing key stakeholders in a customer centric way to ensure that we live by our service principles
• Keeping up to date with product changes and benefits to ensure that all key stakeholders are accurately serviced
• Continuously staying abreast of all digital servicing tools within the business and ensuring that the functionality is fully understood
• Achieving and exceeding key performance metrics relating to service delivery
• Keeping abreast of continuous process, product updates and digital tools
• Dealing with multiple interactions
• Consistently utilizing all servicing tools available

Competencies and Skills

Behavioural Competencies

• Following instruction and procedures (Self-development)
• Analysing  (Managing Complexity)
• Learning and Researching (Nimble Learning)
• Presenting and communicating information (Communicating effectively)
• Delivering results and meeting customer expectations (Customer focus)
• Deciding and initiating action (Decision Quality)
• Working with people (Collaborating)
• Writing and reporting (Communicating effectively)

Knowledge

• Anatomy and Physiology

Skills

• Time Management
• Verbal and written communication
• Working under pressure

Personal Attribute and Skills:

Customer Centric

• Able to work during international business hours (UK Time zone)

Education and Experience

Education:

• Matric

Experience

• At least 6 months working experience in a customer services or clinical environment

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Key Purpose

• To deliver world class service to all Discovery Health Members, Providers, Employer groups, and  Brokers by supporting and fully resolving their queries through various channels, primarily over the telephone.

Key outputs

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

• Servicing all key stakeholders telephonically and via other servicing channels as required until the query has been resolved
• Servicing our members in a customer centric way to ensure that we live by our service principles
• Keeping up to date with product changes to ensure that all key stakeholders are accurately serviced
• Continuously staying abreast of all digital servicing tools within the business and ensuring that the functionality is fully understood
• Achieving and exceeding key performance metrics relating to service delivery

Competencies and Skills

Behavioural Competencies

• Delivering results and meeting customer expectations
• Presenting and communicating information
• Writing and reporting
• Analysing
• Deciding and initiating action
• Working with people
• Achieving personal work goals and setbacks
• Following instructions and procedures

Skills

• Excellent verbal and written communication skills;
• Excellent administration skills;
• MS Office and PC literate
• Time Management

Personal Attribute and Skills:

• Customer Centric
• Empathetic

Education and Experience

Education:

• Matric with Mathematics or Accounting
• Having a achieved a minimum of 50% in English in Matric
•  Basic MS Office Skills

Experience

• At least 12 months working experience in a customer services environment

Advantageous

• The Business Writing Skill