Talent Pool: Clinical Specialist

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Accountable for clinical risk management processes, operationalizing process improvements, interpreting requirements from various stakeholders and collaboratively constructing meaningful conceptual to implementation rules and data mapping requirements for BSS configuration and Business transformational efforts, ensuring that the business processes and system capabilities are aligned to service delivery.

Internal Process

• Engage business stakeholders regularly on key operational processes in regards to Products, Systems, Content and Processes that will improve business outputs.
• Review clinical and technical data and identify how better to structure the data collection requirements and processes. Analyse trends to develop rules set required to increase straight through processes.
• Map data and implement more data collection requirements to enhance the data visualization outputs of value demonstration.
• Design content required for more skillful rule authoring requirements for operational and system processes.
• Identify training needs of the greater business team and engage collaboratively to support business leaders to address the gaps.
• Conduct gap analysis and provide feedback to team members and managers throughout the process.
• Annual updating of department process documents and process library.
• Responsible to provide input to update training material that will help employees understand the subject matter more effectively and efficiently.
• Liaise with trainers to ensure that their training material is accurate and continuously updated.
• Deliver on service level agreements made with clients and internal and external stakeholders to ensure that client expectations are managed.
• Develop and maintain productive and collaborative working relationships with peers and stakeholders.
• Positively influence and participate in change initiatives.
• Continuously develop own expertise in terms of professional, industry and legislation knowledge.

Client Service

• Build and maintain relationships with clients and internal stakeholders.
• Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within area of responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
• Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advise and after sales service.
• Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.

People

• Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.
• Positively influence and manage change and offer specialist support where required.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
• Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management
• Take ownership for driving career development.

Finance

• Contribute to the development of area specific budgets to minimize expenditure, in alignment with operational plans.
• Identify solutions to enhance cost effectiveness and increase operational efficiency.
• Implement and provide input into governance processes, systems and legislation within area of specialisation.
• Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes.
• Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.

• Matric or Grade 12 as a minimum requirement
• Qualification as a Registered Nurse and registered with SANC is essential
• Training or coaching qualification is advantageous
• 3-5 years operational experience is essential
• 3-5 years of experience in Managed Health Care is essential (especially understanding the CMS requirements and standards associated with the Medical Schemes Act, Regulations and Guidelines and Accreditation Standards)
• Claims Assessing experience is advantageous
• Experience in interpreting and applying scheme rules correctly

Attributes

• Knowledge of the NHRPL (National Health reference Price List – previously known as BHF), SAMA tariffs, ICD10, CPT (CCSA) coding is advantageous  
• Deep knowledge of the Medical Schemes Act and the relevant Regulations
• Sound communication skills (both Written & Verbal)
• Computer literacy (Email, Word and Excel)
• Diversity and Inclusiveness
• Collaboration, Adaptability, Results driven
• Teamwork
• Proactive
• Ability to work under pressure
• Strong organisation skills
• Attention to detail and high level of accuracy
• Ability to multi-task

• Business Acumen - Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group.
• Client Commitment - Anticipates, meets and exceeds client's needs by creating long lasting relationships that support the client's value proposition, supports their financial wellness and ensure client centricity.
• Drive for Results - Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
• Leads Change and Innovation - Actively leads change, does what is right for the business and drives continuous improvement through innovation.
• Collaboration - Prioritises the business interests of Momentum Health and invests in the success of the group by aligning effort across divisions.
• Impact and Influence - Persuades, convinces, influences and inspires others, both within Momentum Health and externally to win support, loyalty and gain commitment to the purpose of Momentum Health.
• Self-Awareness and Insight - Manages self and relationships with others effectively and provides perspective in difficult situations.
• Diversity and Inclusiveness - Is sensitive to individual and cultural similarities and differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.