Specialist: Case Manager at Liberty Group South Africa

Purpose

To provide specialist advice and support in the assessment and approval of benefit authorisation/s, in order to manage the clinical and financial risks of the products, through the execution of predefined objectives as per agreed (SOPs).

Minimum Experience

2 - 3 years experience in a similar environment

Minimum Qualifications

Bachelor`s Degrees and Advanced Diplomas [NQF Level 07] in Promotive Health and Developmental Services

Additional Minimum Qualifications

Outputs

Process

• Treat information as private and confidential and do not disclose to any parties unless required to do so by an authorised party.
• Apply relevant research methodologies, tools and techniques to effectively and purposefully gather information.
• Adhere to identified best practices in providing advice and support from a specialist perspective.
• Effectively assess requests related to product benefits that require authorisation in order to manage associated clinical and financial product risks.
• Provide specialist advice and support in area of accountability to ensure that identified solutions and recommendations are appropriate and effective.
• Ensure the ongoing case management of high cost cases and cases outside of standard clinical protocols.
• Ensure that the rules in relation to the benefits requiring authorisation are correctly loaded based on conducted test cases.
• Educate and train relevant stakeholders on the case management process and legislative requirements pertaining to it.
• Capture results and medical observations on the relevant system and provide accurately interpreted results.
• Provide input on, liaise with and source medical practitioners.
• Accountable for the execution of specialised work including the improvement of quality, standards and outputs within defined work routines and operating procedures.
• Proactively solves problems, determines root-cause and applies solutions in line with guidelines and providing the necessary information to solve problems related to area of specialisation.
• Plan for own task execution and advises on improvements related to area of specialisation.

Customer

• Ensure own understanding and adherence to customer service delivery and Treating the Customer Fairly (TCF) principles to provide specialist support and guidance.

Finance

• Adhere to specified standards, policies and procedures to prevent potential losses/wastage related to the area of specialisation.

Learning and Growth

• Interact proactively with others for the purpose of continuous knowledge sharing; and integration of own new knowledge.
• Contribute positively to own area-specific knowledge improvement associated with area of specialisation.

Governance

• Comply to set governance and compliance procedures and processes related to an area of work and continuously identify, rectify and escalate risks where necessary.

Competencies

Liberty Values

Technical Competencies

• Fraud Investigation (Proficient)
• Claims notification and investigation (Proficient)
• Industry Related Knowledge (Medical) (Intermediate)
• Research and Information Gathering (Basic)
• Reporting and Interpretation (Basic)
• Customer Advice (Technical) (Basic)
• Insurance products and services (Intermediate)

Behavioural Competencies

• Professional/Technical learning (Basic)
• Analytical Thinking (Proficient)
• Organisation and Attention to Detail (Basic)
• Interpersonal Effectiveness (Basic)
• Problem Solving and Analysis (Basic)
• Teamwork and Cooperation (Basic)
• Communicating with Impact (Basic)
• Relationship Management and Networking (Intermediate)
• Customer Orientation (Basic)