Jobs at Discovery Limited

Key Purpose:

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 all low acuity admission requests
• Quality of processes

Competencies:

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

• Ensures accountability.
• Action oriented
• Manages ambiguity.
• Attracts top talent.
• Business insight
• Collaborates
• Communicates effectively.
• Manages complexity.
• Manages conflict.
• Courage
• Customer focus
• Decision quality
• Develops talent
• Values differences
• Directs work.
• Drives engagement
• Financial acumen
• Global perspective
• Cultivates innovation.
• Interpersonal savvy
• Builds networks.
• Nimble learning
• Organizational savvy
• Persuades
• Plans and aligns.
• Being resilient

Resourcefulness

• Drives results
• Demonstrates self-awareness.
• Self-development
• Situational adaptability
• Balances stakeholders
• Strategic mindset
• Builds effective teams.
• Tech savvy
• Instils trust.
• Drives vision and purpose
• Optimizes work processes

Education and Experience:

The following requirements are essential:

• 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 ( working hours are between 08:30 -17:00 & travel up to 50KM may be required)
• Effective Communication Skills (Verbal & Written)
• Telephone Etiquette
• Active Listening Skills

The following requirements are 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

Personal Attributes or Competency Profile

The Discovery Person

• Values Driven
• Optimistic
• Learns on the Fly
• Resilient
• Instils Trust
• People Savvy
• Drives Results
• Problem Solver

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Key Purpose

• To develop unique, data-driven solutions to problems faced within the operational processes for Insure. This includes optimizing and generating efficiencies in claims, sales and servicing processes using statistical, actuarial and data science techniques. This role offers the opportunity to apply machine learning and generative AI to solve a large variety of business problems practically.

Areas of responsibility may include but are not limited to

• Developing supplier scoring and evaluation algorithms.
• Optimizing and automating supplier appointments and allocation.
• Using generative AI to optimize business processes.
• Procurement (supplier) analytics.
• Claims analytics.
• Servicing analytics.
• Enhancing Insure’s fraud models.
• Piloting and testing the latest AI innovations to generate efficiencies within Insure

Skills

• Strong problem-solving skills
• Analytical and technical skills
• Solution-oriented mindset
• Working with People
• Presenting and Communicating Information
• Deciding and initiating action           
• Writing and Reporting
• Creating and Innovating
• Curiosity

Education and Experience

Education:

• Matric (Essential)
• Honours degree in Actuarial Science and/or Mathematical Statistics/ Computer Science or Strong mathematical/economics candidate (Essential)
• Good progress on actuarial exams, preferably academically qualified

Minimum Experience:              

• At least 1-3 years Research and Development experience within Insurance industry (Advantageous)

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Key purpose

• The Employee Benefit Advice Specialist plays a critical role in providing employees with comprehensive support and guidance on their health-related benefits. Key responsibilities involve onboarding new hires onto the Discovery Health Medical Scheme (DHMS), facilitating enrolment in Vitality, and introducing GAP cover as part of the onboarding process.
• The specialist is further responsible for managing escalated medical aid-related queries from all staff, ensuring service excellence, maintaining compliance, supporting key internal events, preparing reports, and contributing to ad hoc strategic initiatives.

Key Outputs

The successful individual will be required to perform on, but not limited to the following key outputs:

• Timely Enrolment: Successfully onboard all new hires onto the Discovery Health Medical Scheme (DHMS) within their first month.
• Vitality Program Participation: Promote enrolment in Vitality Premium, and where not feasible, ensure enrolment in Vitality Active.
• GAP Cover Marketing: Introduce GAP cover during onboarding and capture selections for activation.
• Ongoing GAP Cover Engagement: Promote GAP cover to the existing portfolio to enhance overall benefit participation.
• Effective Escalation Management: Manage and resolve all escalated medical aid issues efficiently, ensuring employee satisfaction.
• Member Service Excellence: Provide prompt and effective assistance to all members, ensuring positive service experience.
• Accurate Administration: Complete all daily administrative tasks accurately and efficiently to support seamless operations.
• Compliance Adherence: Submit and upload all required compliance documents timeously, maintaining a low DPMO (Defects Per Million Opportunities) score.
• Ad hoc Projects: Participate in ad hoc projects that align with the strategic vision of            Discovery Connect.
• Active Event Participation: Actively support Core Induction Day 1, Vitality in Action Day events, and other key team activities.

Personal attributes and skills

The successful individual will be required to demonstrate the following competencies:

• Action oriented
• Communicates effectively
• Builds networks
• Drives results
• Ensures Accountability

Qualification & Experience

Essential Requirements:

• Matric
• RE5 certification
• 1-2 years’ experience in a client-facing advisory role

Advantageous Requirements:

• NQF level 4-6
• RE1 certification
• Accreditation to sell Health and Life products
• Tertiary Qualification in Financial Planning