Talent Pool: Clinical Specialist MMH251118-9

Talent Pool: Clinical Specialist MMH -9 Location: Momentum Centurion, Gauteng, South Africa Role Purpose: Accountable for clinical risk management processes, operationalizing process improvements, interpreting requirements from stakeholders and collaboratively constructing meaningful rules and data mapping requirements for BSS configuration and business transformation, ensuring alignment of business processes to service delivery. Requirements Matric or Grade 12 as minimum requirement Qualification as a Registered Nurse and registered with SANC (essential) Training or coaching qualification (advantageous) 3‑5 years operational experience (essential) 3‑5 years experience in Managed Health Care, especially CMS requirements, Medical Schemes Act, regulations, guidelines, accreditation standards (essential) Claims assessing experience (advantageous) Experience in interpreting and applying scheme rules correctly Attributes Knowledge of the NHRPL, SAMA tariffs, ICD‑10, CPT (CCSA) coding (advantageous) Deep knowledge of the Medical Schemes Act and relevant regulations Strong communication skills (written & verbal) Computer literacy (email, Word, Excel) Commitment to diversity and inclusiveness Collaboration, adaptability, results‑driven Teamwork, proactive, ability to work under pressure Strong organizational skills, attention to detail, high accuracy Ability to multitask Duties and Responsibilities Internal Process Engage business stakeholders on operational processes (products, systems, content, processes) to improve business outputs Review clinical and technical data, identify better data collection requirements, analyze trends to develop rule sets increasing straight‑through processes Map data and implement new data collection requirements to enhance data visualisation outputs Design content for skillful rule authoring for operational and system processes Identify training needs of business teams and collaborate with leaders to address gaps Conduct gap analysis and provide feedback to team members and managers Update department process documents and library annually Input to update training material for employee effectiveness Liaise with trainers to ensure accurate, up‑to‑date training material Deliver on service level agreements with clients and stakeholders, manage expectations Develop and maintain productive relationships with peers and stakeholders Influence and participate in change initiatives Continuously develop expertise in professional, industry, and legislation knowledge Client Service Build and maintain relationships with clients and internal stakeholders Deliver on SLAs for clients and stakeholders, ensuring expectations managed Make recommendations to improve client service and fair treatment of clients Contribute to culture building rewarding relationships, facilitating feedback, exceptional client service Monitor turnaround times and quality standards, resolve issues quickly to enhance delivery Drive client service delivery goal achievement to ensure appropriate advice and after‑sales service Manage client query processes, ensuring accurate resolution and improvement of service People Build strong relationships through specialist know‑how and leadership Continuously develop expertise in industry and subject matter development Positively influence and manage change, offer specialist support where needed Contribute to innovation through new ideas and colleague involvement Participate in culture of work‑centric thinking, productivity, service delivery, quality management Take ownership of driving career development Finance Contribute to area‑specific budget development to minimise expenditure, aligned with operational plans Identify solutions to enhance cost effectiveness and increase operational efficiencyl Implement and provide input into governance processes, systems and legislation within the area Escalate unresolved policy and governance compliance issues appropriately Provide input into risk identification processes and communicate recommendations #J-18808-Ljbffr