Current Opportunities at PPS

Job Advert Summary    

• To analyze, reconcile, process information on a Claims account. To assess various type of claims submitted electronically / paper or received via fax or e-mail.  Assessing must meet both quality and quantity set standards.  To do corrections on accounts as requested by other departments or the Scheme.  To complete Reversals as requested by Internal Clients or any other third parties.

Minimum Requirements    

• Grade 12
• Tertiary Qualification

Experience

• Medical Scheme Administration Experience 2 years essential
• Assessing experience 2 years plus essential
• Extensive understanding of the Administration System essential
• Knowledge of Reference Price List essential
• In-depth knowledge of Medical Scheme Rules essential
• MS Office
• Medical Scheme Act essential
• Knowledge of Medical Aid Legislation and regulations essential
• Knowledge of ICD 10 codes essential
• Knowledge of PMB legislation essential

Duties and Responsibilities    

• Reconcile member or provider claims received.
• Accurate daily assessing of targets.
• Manage quality error percentage.
• Ensure consistent and excellent application of set standards and Scheme Rules.
• Excellent administrative skills e.g. daily record keeping.
• Escalate requests for corrections to relevant Consultant.
• Follow up and resolve routed enquiries.
• Good Communication
• Good administration skill’s, including record keeping and the ability to work under pressure
• Must maintain a high level of productivity to asses claims daily targets set
• High attention to detail in order to identify system risks or process shortfalls
• Must be quality aware and quantity orientated
• Operating System knowledge
• Excellent time management in order to manage deadlines
• Excellent in query resolution

Closing Date    
2023/06/30

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Purpose

• The role will be responsible to review, interpret and analyse business rules and requirements for technical systems to ensure that quality solutions are selected and delivered to the business.
• Be responsible for Business process design, mapping, and ongoing process improvement initiatives.
• Accountable to perform the business analysis, business case development and the delivery of process or technological solutions to meet business requirements and objectives.

Minimum Requirements    

• Document business and technical specifications as required: Use cases, activity diagrams, sequencing diagrams, entity relationship diagrams, deployment diagrams, etc.
• Supplement rules and requirements with functional, non-functional & technical specifications, document these as solution acceptance criteria.
• Involve in the designing and establish processes in such a way that the business can derive the maximum value from the technical systems.
• Client, business and MIS report enhancements and development of new reports.
• Assess impacts to processes/systems by legislative/regulatory changes in the industry.
• Assist with client services support, client quality assurance, testing, adhoc projects and project management from time to time.
• Documentation of processes to be used as training manuals.
• Collecting; understanding and transmitting business requirements for all projects and translating these into functional specifications and detailed test plans.
• Bring about operational efficiency through development of interface capabilities with third party vendors, workflow tools, new in-house systems.
• Act as the link and drive interactions between the client, development team and any third party throughout the development lifecycle.
• Transfer of business new product/initiative requirements to system architects.
• Responsible for the delivery of quality Business requirements specifications within the agreed timelines and customer requirements always visibly reflected in all business documents.
• Ensuring that teams apply the appropriate solution design standards so that customer requirements, automation, Digitisation and Artificial Intelligence have relevance where required in the formulation of the solution.
• Develop operational service metrics as part of the business requirement, review and present the metrics explaining business impact and risk.
• Maintain business process management standards and procedures.
• Oversee and track progress of all required Business Requirements to ensure that deliverables are not compromised.
• Demonstrating the ability to facilitate and guide the completion of Business Analysis Artefacts, participate in the formulation of flexible Solution Designs, and produce Quality documentation.
• Constructively engaging with Business Stakeholders to ensure that customer requirements are understood and providing innovative thinking.
• Ensure that a structured work approach is adopted using quality, governance, and customer service as the top-of-mind business requirements practices.
• Ensure that thought leadership, guidance, direction, quality, and best practices are adopted in the eliciting of Business Requirements and or in the completion of business research. 
• Ensure that a consistent methodology and business requirements framework is adopted when interacting with all business and or technology partners in the formulation of business solutions.  
• Focus on outcomes-based deliverables and have an in- depth understanding of the Business Architecture and what attributes and business processes are to be considered during the eliciting of requirements.  
• Understanding IT dependencies and inter – dependencies ensuring that the end-to-end business value chain is not compromised.
• Understanding the IT landscape to ensure that solutions designed are not in conflict with the IT architecture.

Duties and Responsibilities    
Education:

• BCom (IS)
• BCom Hons, B Bus Sc with a specialization in Investment Management or Computer Science fields (with strong Mathematical background or subject knowledge an advantage).
• Business Design and or Business Analysis diploma
• SAFE Agile Certification or other AGILE development training

Experience:

• Business Analyst with at least 5 years’ experience within financial industry.
• Previous project management experience will be advantageous.
• Experience in participating in complex multi-team delivery models.
• Detailed experience in understanding business incidents, change and priority management.
• Experience in understanding and translating insurance related regulations into actions.
• Exposure to Robotics would be advantageous.

Knowledge and Skills:

• In-depth knowledge of the full end-to-end services, systems, and processes for an insurer
• Understanding of systems interactions within the context of business process delivery (i.e., workflow system, CRM, BPM, batch systems and data warehousing).
• Knowledge and ability to apply Business Architecture and Business Process Management principles.
• Proven knowledge of general business principles and practices, including financial and people management in a matrix structure.
• In depth knowledge of Process Management
• Proficient knowledge in implementing business methodologies including problem management/incident resolution.
• Understanding of Systems development Life Cycles
• Ability to implement and improve the competence of Business Analysis within Business Engagement
• Demonstrating the ability to lead and guide the completion of Business Analysis Artefacts, participate in the formulation of flexible Solution Designs, and produce Quality documentation.
• Having had exposure in understanding business incidents, change and priority management.
• Proficient in Agile methodology and practices

Competencies:

• Able to navigate ambiguity and complexity.
• Enabling and ensuring that team is customer focused whilst demonstrating detailed feedback to all stakeholders.
• Able to maintain a professional demeanor under stress, is persistent and resilient.
• Demonstrating problem solving and analytical skills
• Constructively engaging with Business Stakeholders to ensure that customer requirements are understood and providing innovative thinking.
• Design thinking
• Teamwork

Closing Date    
2023/06/20

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Job Advert Summary    

• To assume responsibility, initiate strategy and oversee the delivery of actuarial and risk-related activities within the PPS Short-Term Insurance business. This position will be a junior Executive Committee position.

Minimum Requirements    
Qualification:

• Degree in Actuarial Science
• Qualified Fellow Actuary

Knowledge & Experience:

• > 10 years.
• Experience in the Short-Term Insurance Industry.
• Project Management.
• Strategic Thinking and Business Acumen.
• Enterprise Risk Management experience will be beneficial.
• Strong technical and problem-solving skills.
• Senior stakeholder reporting, engagement, and communication skills.

Duties and Responsibilities    

• Initiate and oversee strategic objectives for the Actuarial and Risk Department.
• Oversight of the maintenance, updating, implementation and delivery of first-line corporate actuarial items (including regulatory reporting, reserving, regulatory and economic capital calculations).
• Be responsible for the design, implementation and delivery of pricing and product development strategies and activities (including reinsurance).
• Assume responsibility for the continued embedment of the PPS Enterprise Risk Management Framework (including the maintenance, enhancement, coordination, and reporting on Combined Assurance activities) within the business.
• Ownership of the entire ORSA process.
• Manage and develop a small team of individuals.
• Reporting on departmental activities and strategic outcomes.
• Development of strategies and solutions for business challenges.
• Development and maintenance of strong processes and working relationships with various stakeholders in the company and the wider Group.

Closing Date    
2023/06/27

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Job Advert Summary    

• A challenging opportunity for a dynamic, quality orientated Service Manager with proven leadership and people management skills exists. To promote the delivery of a consistently superior customer experience, the successful candidate will utilise their effective planning and organising abilities to drive the day-to-day management of the Group’s resources to meet the contractual service levels, standards and targets.

Minimum Requirements    

• A minimum of a Grade 12 and Registered Nursing qualification.
• Sound Clinical knowledge.
• Exposure to Managed HealthCare policies and procedures, ISO principles and other related legislature would be an added advantage.
• Ability to effectively communicate at all levels.
• Computer literacy (MS Office and Medical Administration system).
• Management experience.

Duties and Responsibilities    

• Maintenance of effective communication amongst all stakeholders.
• Effective monitoring and maintenance of the day-to-day operations to ensure adherence to set standards and targets.
• To offer creative solutions in the day-to- day operations.
• Evaluation and support of the Groups training needs and compile action plan and provide feedback on performance and customer feedback.
• Analysis of the Product/Industry changes and sporadically review processes in order to identify risks or possible improvement suggestion within the group.
• Planning and efficiently implementing approved operational changes to effectively respond to important external influences in a way that maintains operational best practice.
• Compile reports of the departmental activities for presentations to the stakeholders
• Client management and management of escalations.
• Staff planning
• Supporting the HOD: Managed HealthCare to implement business plan in a manner that supports operational and quality standards that meet the defined departmental priorities.
• Management of staff including their performance management.
• Escalate system problems including hardware faults timeously.
• Promote and adhere to PPSHA Values.

Closing Date    
2023/06/21