Legal Advisor

2 weeks ago

Sandton, South Africa Discovery Ltd. Full time

Business Unit:
Discovery Health
Function:Legal Affairs
Date:05-Jan-2023About Discovery

Discovery's core purpose is to make people healthier and to enhance and protect their lives.

We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery.

Our fast-paced and dynamic environment enables smart, self-driven people to be their best.

As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

Key Purpose

Key Outputs

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

  • Oversee legal advisor in drawing up the Heads of Arguments (HOA) for all Disputes.
  • Drawing up of all Section 48 hearings and Section 50 hearings at Council of Medical Schemes (CoMS)
  • Argue cases at CoMS for Section 48 Hearings as an admitted attorney and whenever possible for Section 50 Hearings.
  • Oversee the legal advisor in arguing cases before the Disputes Committee on behalf of DHMS at weekly Dispute Hearings.
  • Provide general legal advice internally for matters related to the Scheme rules and interpretation of the PMB legislation for which this position bears the legal responsibility.
  • Respond to legal letters of demand from members within strict deadlines as main legal respondent on behalf of DHMS and other Discovery Health administered schemes.
  • Manage the mediation process before a matter goes on appeal.
  • Own legal relationship, in terms of Disputes and CoMS complaints, with the Discovery Health Senior Executive and Discovery Health Medical Scheme.
  • Providing input and representation at relevant senior forums throughout the Discovery Health business.
  • Own legal responses to CoMS and maintain positive relationship with all relevant stakeholders.
  • Update the Benefit Compliance Review team and relevant business areas on CoMS and Dispute rulings as required.
  • Provide monthly and quarterly trending and status reports.
  • Track industry trends relating to the Appeal committee and to the Appeal Board decisions; assist with implementation of these decisions into Discovery Health.
  • Accurate record keeping in line with company requirements and standards.
  • Provide legal expertise for complex legal matters across multiple areas when necessary.
  • Develop strategic and operational plans to minimize risk within the area.
  • Assist in ensuring the company complies with legislation (Medical Schemes Act) to avoid statutory and/or regulatory consequences.
  • Act as the liaison and provide the relevant level of instruction to the external legal panel comprising attorneys and advocates.
Competencies

  • 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.
  • Priority Setting: Spends his/her time and the time of others on what's important; quickly zeros in on the critical few and puts the trivial many aside; can quickly sense what will help or hinder accomplishing a goal; eliminates roadblocks; creates focus.
  • Planning: Accurately scopes out length and difficulty of tasks and projects; sets objectives and goals; breaks down work into the process steps; develops schedules and task/people assignments; anticipates and adjusts for problems and roadblocks; measures performance against goals; evaluates results.
  • Managerial Courage: Doesn't hold back anything that needs to be said; provides current, direct, complete, and "actionable" positive and corrective feedback to others; lets people know where they stand; faces up to people problems on any person or situation (not including direct reports) quickly and directly; is not afraid to take negative action when necessary.
  • Action-Oriented: Enjoys working hard; is action oriented and full of energy for the things he/she sees as challenging; not fearful of acting with a minimum of planning; seizes more opportunities than others.
  • Organizational Agility: Knowledgeable about how organizations work; knows how to get things done both through formal channels and the informal network; understands the origin and reasoning behind key policies, practices, and procedures; understands the cultures of organizations.
  • Interpersonal Savvy: Relates well to all kinds of people—up, down, and sideways, inside and outside the organization; builds appropriate rapport; builds constructive and effective relationships; uses diplomacy and tact; can defuse even hightension situations comfortably.
Qualifications & Experience

  • Matric
  • LLB qualification
  • Admitted Attorney or Advocate
  • At least 1 year working experience in the medical scheme environment
  • At least 5 years Litigation experience
  • Knowledge of Managed Care Environment
  • Sound knowledge

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