Medshield Medical Scheme: Supervisor-Membership Clinical Underwriting

Company Medshield Medical Scheme
Reference # SMCU001
Published 16/10/2020
Contract Type Permanent
Salary Market Related
Location Randburg, Gauteng, South Africa
Introduction
Accountable for the underwriting functions within the administration of the Scheme by co-ordinating, planning and delivering day-to-day team activities in order to execute team objectives accurately and timeously, in line with agreed SOPs as well as coaching and mentoring the team with a purpose of achieving the team’s performance and operational objectives.
Job Functions Medical,Operations,Other
Industries Healthcare
Specification
-Provide clinical input to the underwriting team on medical information provided by applicants in order to make accurate individual underwriting decisions.
-Ensure accurate capturing of medical diagnoses.
-Provide training (clinical) internally to assist with application of guidelines.
-Create new and maintain existing list of condition specific exclusions and associated link to required clinical coding.
-Assist brokers, applicants, and members where applicable with regards to underwriting decisions made either telephonically, in writing or in person as required.
-Liaise with doctors and/or medical professionals where applicable with regards to underwriting decisions made either telephonically, in writing or in person as
required.
-Draw on own knowledge and experience to identify and develop solutions to improve operational service & quality.
-Establish, review and enhance underwriting and quality processes in consultation with the Membership Manager
-Coordinate and monitor the departmental operational plan, and objectives to effectively deliver on performance targets.
-Manage the team’s daily operational delivery according to the internal Service Level Agreement, and ensure that procedures are implemented and systems are
operated within the correct governance guidelines.
-Maintain and improve SOPs and guidelines relating to service delivery.
-Responsible for the management of the team, by aligning own work and team work to deliver on performance objectives and in response to changes in processes.
-Contribute to the identification and resolving of operational problems within the department and escalate unresolved problems for resolution.
-Responsible for the compilation of quality departmental reports, create statistical control metrics, and manage discrepancies for continuous improvement.
-Accountable to minimize liability and exposure while facilitating a fair response to complaints and escalation.
-Manage performance of direct reports ensuring execution of annual goals, measuring performance against agreed goals and dealing with non-performance
accordingly.
-Coaching and mentoring of direct reports, and ensure that staff receive adequate and relevant training to support their career development.
Requirements
Experience

-Minimum of 3 years’ experience in a Supervisory role
-3 years’ clinical underwriting experience within the medical aid environment

Qualification

-Nursing diploma or degree

Knowledge

-Legislation
-Risk Management
-Regulatory framework (CMS, MSA)
-Policies and Procedures
-Business acumen
-In- depth knowledge of business processes

Skills

-Oral and written communication
-Analytical thinking
-Project management
-Decision making
-Planning and Organising
-Deadline driven
-Conflict management
-Problem solving
-Presentation skills
-Coach/mentor

Attributes

-Work under pressure
-Professionalism
-Multi-tasking
-Accuracy
-Follow-through
-Customer focus
-Confidentiality
-Customer focus
-Innovative thinking
-Deadline driven
-Diversity management
-Assertiveness

Job Closing Date 19/10/2020

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