Senior Medical Officer
5 days ago
**Job Advert Summary**:
To provide specialist medical input, advice and expertise. Understand how medicine and medical science impactunderwriting 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 claims assessment. To undertake research initiatives within the Research and Development area. Participate in the organisation of strategic projects to support member acquisition, improve risk management and deliver a positive member experience.
**Minimum Requirements**:
**Education**:
- Matric (Grade 12)
- 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
- Adept in the use of the latest MS Office Package, particularly Excel, Word and PowerPoint
- Demonstrates self-control, time management ability, courteousness, patience and the ability to gain control of situations
- Demonstrates curiosity, thinking outside the box, promoting solutions and innovation
- Demonstrates honesty and integrity
- Demonstrates strong business acumen and solutioning within a pragmatic context
- Energetic and enthusiastic, demonstrating drive and passion
- Collaborative and able to provide support when working with others
- Analytical thinking
- Problem-solving and analysis
- Professional and technical medical skills
**Member Experience**:
- Contribute to a TCF and service excellence culture which builds positive relationships and provides
opportunities for exceptional service
- Implement processes which support service delivery excellence according to TCF principles and encourage others to provide exceptional customer service
**Strategy and Innovation**:
- Co-lead and partner with Product Development and other PPS entities in the development of innovative solutions aimed at improving the ease of doing business with PPS throughout the policy lifecycle, from onboarding right through to claims
- Serve on key leadership forums, like the Quarterly Product Forum, to support the development and execution of Member Value Proposition’s (MVP) strategic imperatives
- Provide input into strategic projects by understanding the business needs and implications for the area of specialisation
- Provide insights and opinions on strategic initiatives
- Execute strategic deliverable
PPS has in place a COVID-19 Vaccination Policy, which applies to all employees as a term and condition of
**Duties and Responsibilities**:
**Main duties and responsibilities**:
**Ongoing medical research**:
- Conduct research and collate data to influence and substantiate PPS’ underwriting and claims assessment guides
- Conduct research and collate data to serve as input into product development initiatives related to the area of specialisation
- Advising on any 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 existing underwriting policies
- Participate in underwriting quality control through the validation of underwriting decisions
- Assist with disputed Underwriting outcomes, and 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
**Claims**:
- Plan for and process medical-related tasks and activities effectively and efficiently in alignment with performance objectives
- Medical assessment and authorisations of complex or high-value claims
- Participate in the design of new claims guidelines and review existing claims guidelines
- Chair and monitor the effectiveness of the Medical Officers Committee in accordance with Terms of Reference
- Participate in claims quality control through the validation of claims assessment decisions
- Monitor the performan
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