New Jobs at Discovery Limited

Key Purpose

• The purpose of this role is to support design, implement, and manage drug benefits, including price negotiation and clinical coding. The clinical pharmacist will support the development of benefit rules, conduct research, evaluate products, validate claims, support stakeholders, assist with policy decisions, analyse data, and stay updated on clinical developments.

Areas of responsibility may include but not limited to

• Drug Benefit Design Support for DHMS and In-House schemes (E.g. Formularies, Medicine reference pricing)
• Price negotiation support – pharma liaison, price negotiation support for all benefits
• Utilisation of drug product price files with clinical coding and benefit groupers for assistance with and involvement in:
• Drug Benefit Rule development, enhancement and maintenance.
• Clinical research and product evaluation for Drug formularies and drug claims validation rules
• Drug benefit and policy documentation
• Pharmaceutical coding analysis for new drug benefit design
• Drug Strategy and project support
• Internal stakeholder support with drug benefits and rules
• Drug Benefit Rule support to the internal PBM as well as assistance with PBM queries
• Keeping up to date with new clinical developments [e.g. new drugs, protocols, guidelines etc.]
• Support to the policy and HTA team regarding reimbursement and benefit decisions
• Drug claims data analysis supporting risk management projects and strategies.
• Clinical tool development including clinical coding crosswalks for drug risk management and monitoring
• Adhoc tasks as required.

Personal Attributes and Skills

The following competencies are required to be successful in the role:

• Self-driven and motivated
• Assertiveness
• Resilience
• Strong analytical and problem-solving skills
• Highly developed writing and communication skills
• Time management and planning/organisational skills
• Attention to detail and process management
• Stress management
• Teamwork
• Strong customer focus
• Ability to work extended hours when necessary and within timelines
• Change management and multi-tasking skills

Education and Experience

Education

• Matric
• Professional Pharmacist (4-year degree)
• Post Graduate Pharmacy Degree is advantageous

Experience

Minimum 2-3 years Managed Health Care experience in the following areas:

• Drug formulary development/management/implementation (Essential)
• Therapeutic drug class database knowledge (Pharmaceutical and Industry drug coding) (Essential)
• Drug reference pricing experience in formulary and benefit design (Essential)
• Pharmaceutical coding experience e.g. WHO ATC classification (Essential)
• Drug Utilisation Review and Protocol Development
• Pharmacy Benefit Management (PBM) experience in Drug Benefit Rule  
• Implementation/Management (Acute and Chronic)
• Drug risk profiling /reporting experience an advantage

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Key Purpose of the role

• Assisting the underwriters with general administration related to underwriting. Ensure brokers are well informed by providing accurate information to them in order to adequately support clients. Compile underwriting status reports. Provide or receive half cost medicals from other insurers. Ensure claim assessments and payment of lump sum benefits (Funeral, death, SIB and ICB) payments.

Principle Accountabilities

• Enhance group risk revenue and profit streams to meet business objectives through the following:

Claims:

• Compile claims reports for brokers from SFE and Compass
• Pre-assess or review disability claim applications as per process
• Manage claim related queries and provide the client with feedback thereof
• Receive claims from indexing department for assessment of the funeral and death claims - member; child or spouse claims as well as extended family members.  Assess each claim by verifying claim details against standard claims requirements.  Liaise with Broker should documentation not be in order
• Should discrepancies be picked up, refer the documentation to the Forensics Department.  Ensure regular follow-up until Forensics provide an investigation outcome
• Once all documentation has been received, set up payment on the system for verification by second Assessor and Authoriser
• Receive claims for verification (second assessing) and authorizing
• Issue payment letters and/or claims decision letters to Brokers once payment has been approved

Underwriting:

• To send medicals requirements requests to brokers/SC in order to be completed by member for underwriting members’ over the acceptable limit
• Link the received completed medicals to the system and allocate to the underwriters for a decision
• Ensure all documents submitted are correct and completed in full.  Where documents are missing, source the documents from Meditech or other Pathologists
• Once all documentation is attached on SFE, complete audit for Member and move it to the Underwriters
• Compile underwriting admin reports for brokers from SFE and Compass
• Investigate reasons for anomalies on any underwriting admin process and troubleshoot. Look out for members that need decisions to be re-applied
• Deal with escalated calls or queries to ensure high quality

Education and Experience

• Matric - Essential
• Relevant Industry Qualifications – Advantageous
• MS Office experience especially Excel and Compass- Essential
• Group Life/Risk Insurance experience- Essential
• 3 to 5 years working experience within a Group Life Administration environment

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Key Purpose

• The Information Security Officer (ISO) ensures that the security vision, privacy objectives and strategy is followed by leading the implementation of the Group Wide Security Programme. The ISO works directly with the business senior management team and CIO to facilitate Information Governance and Security, provides guidance and advice on security direction and creates mechanisms to facilitate the management of security risk through appropriate policies, standards and guidelines.

Areas of responsibility may include but not limited

• Provide input into the Group Information Security Strategy with associated programs and leading these within the respective business unit. 
• Engage directly with the CIO and other influential parties to execute the Group and Business Unit Information Security Strategy. 
• Regular engagement with the Business stakeholders ensuring that the Information Security Program and Strategy is aligned to business and systems developments. 
• Assist in the development of appropriate Information Security Policies, Standards and guidelines that are aligned to business outcomes and needs.  
• Identification and assessment of Information Security related risks, identification of controls implemented within the business and co-ordination and reporting of management actions to address shortcomings.  
• Assist with appropriate training and awareness programs or initiatives for all staff to inform them of their information security obligations. 
• Providing ongoing direction, guidance and support to the business on all information security related matters. 
• Regular reporting to and active participation on relevant forums and committees 

Personal Attributes and Skills

• Strong negotiation and mature communication skills 
• Excellent knowledge of technology environments 
• The ability to articulate security in non-technical business impact terms  
• Excellent written and oral presentation skills, ability to lead discussions and present complex ideas to all levels within the organization 
• Business Writing Skills, Presentation and Facilitation Skills 
• Customer Service Orientation, Result Orientation, Negotiation skills 
• Personal organisation and time management skills 
• Time and Task Delivery Management 
• Professional Communication (written, verbal/presenting and listening) 
• Interpersonal skills - Ability to build relationships with people from all different backgrounds and at different job levels 

Qualifications & Experience

Essential  

• Related Degree / Diploma
• 5 years experience in the Information Security field across two or more domains
• Exposure to Risk and Compliance management
• Working knowledge of and experience with Risk and Compliance.
• Working security experience within in large complex corporate environments.
• Working knowledge of applicable industry standards, legislations, etc

Advantageous  

• Information Security Qualifications such as S+, CISSP
• Security Experience within in large complex corporate environments