This position requires the successful candidate to manage legal disputes, as well as to provide legal assistance to Discovery Health when necessary.
Key Outputs
The successful applicant will be responsible for but not limited to the following broad job functions:
- Argue cases at Disputes on behalf of DHMS at weekly Dispute Hearings.
- Manage and own the entire Dispute Process and the relevant workflow pools.
- Assist senior legal advisor to respond to legal letters of demand from members.
- Provide legal assistance in respect of appeals to Council.
- Assist senior legal advisor in managing the mediation process before a matter goes on appeal.
- Provide legal training to the Benefit Compliance Review team when required.
- Update the Benefit Compliance Review team and relevant business areas on Council for Medical Schemes and dispute rulings as required.
- Monthly and quarterly trending and status reports.
- Assist in and provide advice on legal matters pertaining to Discovery Health e.g. Application of the Medical Schemes Act and Regulations to funding decisions.
- Draft heads of arguments for appeal and dispute matters.
- Investigate cases prior to going for disputes.
- Track industry trends relating to the Appeal committee and to the
- Appeal Board decisions, to assist with the implementation into Discovery Health.
- Record keeping according to company requirements.
Problem Solving: Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.
Priority Setting: Spends his/her time and the time of others on what's important; quickly zeros in on the critical few and puts the trivial many aside; can quickly sense what will help or hinder accomplishing a goal; eliminates roadblocks; creates focus.
Planning: Accurately scopes out length and difficulty of tasks and projects; sets objectives and goals; breaks down work into the process steps; develops schedules and task/people assignments; anticipates and adjusts for problems and roadblocks; measures performance against goals; evaluates results.
Managerial Courage: Doesn't hold back anything that needs to be said; provides current, direct, complete, and "actionable" positive and corrective feedback to others; lets people know where they stand; faces up to people problems on any person or situation (not including direct reports) quickly and directly; is not afraid to take negative action when necessary.
Action-Oriented: Enjoys working hard; is action oriented and full of energy for the things he/she sees as challenging; not fearful of acting with a minimum of planning; seizes more opportunities than others.
Organizational Agility: Knowledgeable about how organizations work; knows how to get things done both through formal channels and the informal network; understands the origin and reasoning behind key policies, practices, and procedures; understands the cultures of organizations.
Interpersonal Savvy: Relates well to all kinds of peopleup, down, and sideways, inside and outside the organization; builds appropriate rapport; builds constructive and effective relationships; uses diplomacy and tact; can defuse even high-tension situations comfortably.
Qualifications & Experience
The following requirements are Essential:
- Matric
- LLB qualification
- At least 1 year working experience in the medical schemes environment
- Knowledge of Managed Care Environment
- Excellent written and verbal communication skills in English
- Basic computer literacy in Microsoft Office applications (must be proficient in Excel)
- Drafting of legal documents eg. Heads of Argument, opinions and legal letters
- Knowledge of Discovery Health Medical Scheme and In-House products and protocols
- At least two years experience in large law firm
- Clinical /Medical knowledge
The Companys approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
