Senior Legal Advisor

4 months ago

Sandton, South Africa Discovery Ltd. Full time

**Business Unit**:Discovery Health**Function**:Legal Affairs**Date**:29 Aug 2024
- Clinical Benefit Advisory Team**Senior Legal Advisor**

**About 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.**About Discovery Care**

Discovery Care is a subsidiary for Discovery Health - made up of 8 distinct areas with segmented teams responsible for the processing of specialized claims, CIB queries and escalated clinical queries processes while our case management teams are responsible for reviewing clinical cases for each of the specialized areas. Our clinical services area is also responsible for all council disputes while our high touch team provide hands on services and escalated query resolution to sensitive cases.

**Key Purpose**:**Key Outputs**
- The successful applicant will be responsible for but not limited to the following 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**:

**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
- 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 of relevant Legislation
- Excellent written and verbal communication skills in English
- Drafting of legal documents e.g. Heads of Argument, opinions, and legal letters
- The following requirements are advantageous:
- Knowledge of Discovery Health Medical Scheme and In-House products and protocols
- At least two years’ experience in large law firm
- Clinical /Medical knowledge

**Personal Attributes or Competency Profile**

**The Discovery Person**
- Values Driven
- Optimistic
- Learns on the Fly
- Resilient
- Inst

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