|Company||Medshield Medical Scheme|
|Location||Randburg, Gauteng, South Africa|
Accountable for the update of membership records and the processing of beneficiary application forms to the highest degree of accuracy in line with the membership standard operating procedures and Scheme rules within agreed service levels.
|Job Functions||Administration,Analysis,Medical,Risk Management|
-Verify and accurately process membership applications and member record updates on the administration system.
-Liaise with and follow up on outstanding applicant documentation to ensure that beneficiaries are successfully registered, to assist in minimising Scheme risk and exposure due to incomplete and/or inaccurate information.
-Investigate, record and resolve customer queries effectively and efficiently in accordance with Standard Operating Procedures within agreed Service levels.
-Investigate, prepare, submit special cases for review and provide feedback on the outcome of the review to the query requester.
-Ensure the accurate application of Scheme rules and Standard Operating Procedures in membership data capturing.
-Seek continuous in-depth understanding and knowledge of Scheme rules and updates in order to provide accurate advocacy to members when required.
-Maintain the annual option change process, annual student review, special cases and the year-end take-on process.
-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 all internal, external and ISO audit requirements.
-Maintain quality risk management standards in line with the requirements from ISO9001:2015.
-Maintain and enforce all membership related Service Level Agreements to minimise business risk and ensure business continuity.
-Identify and recommend improvements to membership related Standard Operating Procedures and guidelines in consultation with the Supervisor and Manager: Credit Control to ensure business optimisations.
-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.
-Liaise with members, brokers and 3rd parties in delivering exceptional customer service
-A minimum of 1 year in a similar role
-Regulatory framework (CMS, MSA)
-Risk Management practices and principles
-Technical problem solving
-Medical aid / Insurance
-Nexus Membership experience is a definite advantage
-Oral and written communication
-Planning and Organizing
-Work under pressure
-Speed and Accuracy
|Job Closing Date||28/07/2021|