|Company||Medshield Medical Scheme|
|Location||Randburg, Gauteng, South Africa|
To monitor and evaluate agents daily within the divisions, ensuring processes are followed according to divisional Standard Operating Procedures by identifying gaps in processes, improving on existing processes, and ensuring quality assurance operating procedures are aligned to those of Operations division.
|Job Functions||Analysis,Quality Control|
-Monitor and conduct comprehensive quality assurance assessments against agreed upon quality standards and Standard Operating Procedures.
-Resolve stakeholder queries and escalations in a fair manner applying appropriate expertise in line with Scheme Rules and protocols.
-Conduct root cause analysis, live monitoring, and calibrations when required.
-Work with all the Business areas, to identify gaps in processes, analyse and improve where necessary to increase speed, quality and gain efficiencies.
-Complete quality control reports, non-conformity discrepancy reports, and recommend continuous improvement activities.
-Provide feedback to sub-divisional managers on the quality assurance assessments.
-Forward monthly summaries of quality challenges to the Manager: QA for review and consolidation.
-Ensure that relevant training needs are identified through quality assurance evaluations, and liaise with Learning and Development on training needs and required material.
-Participate in the determination, negotiation and agreements of in-house quality procedures, standards and/or specifications per division.
-Conduct regular audits to determine the level of compliance to quality standards within the Scheme.
-Provide support in the implementation of quality assurance special projects, promotions, campaigns and awards.
-Assist in identifying and adhering to fraud controls, risk prevention principles, sound governance and compliance processes, and tools to identify and manage risks.
-Support and provide evidence to internal, external and ISO audit requirements.
-Maintain quality risk management standards in line with the requirements from ISO9001:2015.
-Maintain and enforce all quality assurance related Service Level Agreements to minimize business risk and ensure business continuity.
-Review related Standard Operating Procedures in consultation with the Supervisor and Manager: Quality Assurance to ensure business optimization.
-Adhere to all relevant laws, policies and Standard Operating Procedures throughout the organisation
-Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing and integration.
-Conduct individual training and workshops on non-conformities identified and provide feedback to relevant stakeholders.
-Provide support to the Scheme’s business units when required to achieve business goals
- 2 Years in Quality Assurance
-A minimum of 5 Years within the medical aid industry
- 5 years Claims experience
- Scheme support services processes (advantage)
- A business Re-Engineering and or a Business Analysis qualification/certification
-Relevant legislation and regulatory frameworks
-Risk Management practices and principles
-Quality Control principles
-Verbal and Written Communication
-Coaching and Mentoring
-Judgement and Decision-Making
- Team player
|Job Closing Date||29/03/2020|