Senior Medical Officer

1 week ago

Johannesburg, South Africa PPS Recruitment Full time

**Job Advert Summary**:
To provide specialist medical input, advice and expertise. Understand how medicine and medical science impacts underwriting and claims and broader risk management within the long-term insurance business environment. The key purpose of this role is to provide general medical input, advice and expertise regarding product development, risk underwriting and claim assessments. To undertake research initiatives within the Research and Development area. Participate in organisation strategic projects to support member acquisition, improve risk management and deliver a positive member experience.

**Minimum Requirements**:
**Education**:

- Matric.
- MBChb

**Experience**:

- Minimum of 5 years’ experience post full qualification as a Medical Doctor / Medical Officer.
- Management experience would be an advantage.
- Experience in occupational health, psychiatry or cardiology would be an advantage.
- Experience in Long-term insurance would be an advantage

**Knowledge and Skills**:

- Demonstrates awareness of market trends and opportunities and keeps up to date with competitor developments impacting area of responsibility.
- Is adept in the use of the latest MS Office package, particularly Excel, Word and Power-point.
- Demonstrates self-control, an ability to manage your time, be courteous, be patient, be able to gain control of situations.
- Demonstrates curiosity, think outside the box, promote solutions, innovate.
- Demonstrates honesty and integrity.
- Demonstrates strong business acumen, and solutioning within a pragmatic context.
- Is energetic, demonstrates drive, passion and is enthusiastic.
- Be collaborative and provide support when working together.
- Analytical thinking.
- Problem solving and analysis.

**Competencies**:

- Sense of urgency to achieve timely, quality results.
- Work within established standards and guidelines.
- Expertise-based problem solving.
- Pro-active, problem solving orientation.
- Authoritative, quick decision making based on knowledge and experience.
- Communication is task based and factual.
- Minimal collaboration is required, when it is, it is task or technically focused.
- Authoritative leadership.
- Is confident in communicating specialized expertise, knowledge.
- Directive leadership to meet established quality and time standards.

**Duties & Responsibilities**:
**Ongoing medical research**:

- Conduct research and collate data to influence and substantiate PPS’ Underwriting and Claims assessment guidelines
- Conduct research and collate data to serve as input into product development initiatives related to area of specialisation.
- Advising on possible medical related risks that the organisation may be exposed to e.g. epidemics, new legislation etc.
- Advising on medical topics pertaining to the company’s business

**Underwriting**:

- Plan for and process medical related tasks and activities effectively and efficiently in alignment with performance objectives.
- Medical assessment of complex new business cases in accordance with PPS underwriting guidelines and risk appetite.
- Participate in the design of new underwriting policies and review of existing underwriting polices.
- Participate in underwriting quality control through validation of underwriting decisions.
- Assist with disputed underwriting outcomes, Internal Arbitrator or Ombudsman complaints.
- Monitor performance of the underwriting function and recommend ways to improve it both operationally and clinically.
- Draw on own technical or professional knowledge and experience to identify and develop solutions to improve ease of doing business and service quality.
- Implement and provide input into the development of governance and compliance processes within area of specialization.
- Provide input into the design and development of underwriting automation solutions

**Duties and Responsibilities**:
**_ Duties & Responsibilities continued:_**

**Claims**:

- Plan for and process medical related tasks and activities effectively and efficiently in alignment with performance objectives.
- Medical assessment and authorisation of complex or high value claims.
- Participate in the design of new claims guidelines and review of existing claim guidelines.
- Chair and monitor effectiveness of the Medical Officers Committee in accordance with Terms of Reference.
- Participate in claims quality control through validation of claim assessment decisions.
- Assist with disputed claims, Internal Arbitrator or Ombudsman complaints.
- Monitor performance of the claims function and recommend ways to improve it both operationally and clinically.
- Draw on own technical or professional knowledge and experience to identify and develop solutions to improve ease of doing business and service quality.
- Implement and provide input into the development of governance and compliance processes within area of specialization.
- Provide input into the design and development of claim automation solutions

**Product

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