Risk Specialist at Discovery Limited

Job Purpose

• The position exists within the Corporate Contracting team where the key purpose is managing risk in a range of areas under such as hospitals, pathology and radiology related costs and influencing business strategy for all administered medical schemes through various risk mitigating strategies and projects. Develop, manage and co-ordinate projects and initiatives related to pathology spend.

Areas of responsibility may include but not limited to

• Proactively engage with analysts in understanding risks to the schemes.
• Identify risk, trends in terms of hospital spend and development of sustainable solutions
• Regular engagement with hospitals, pathology and radiology groups funder relations on related initiatives as well as internal stakeholder management.
• Product or benefit redesign through the R&D process and provider contracting
• Management and maintenance of hospitals, pathology and radiology benefits, input on escalated cases and review of benefits\protocols.
• Implementation and monitoring of new products\projects and pathology tariffs.
• Development of hospital DSP status with alternative reimbursement models (ARMs) and monitoring.
• Ability to provide support for the broader SRM and Operational team, work closely with systems and functional teams to ensure that all requirements are aligned with business plan, to ensure timeous delivery of projects.
• Producing regular monitoring reports, as well as detailed investigation outcomes.

Qualification Requirement

• Clinical qualification
• Relevant Business Bachelor’s Degree (Advantageous)

Essential experience

• Risk Management skill or experience
• 3-5 years managed healthcare industry experience
• Basic ICD-10 and CCSA coding and other coding Schema’s (RPL and UPFS) knowledge and experience

Advantageous experience

• Advantageous - Good knowledge of Discovery Health Pathology products and protocols
• Technical Skills or Knowledge
• Strong analytical skills, strong Excel, and PowerPoint skills.  Proven problem-solving skills. Good project management skills
• Effective communication skills (verbal & written)
• Knowledge of Discovery Health systems (internal only)