Current Vacancies at Momentum Metropolitan Holdings Limited

Role Purpose    

• Ensuring hospital claims are audited timeously and accurately as per our service level agreement, focusing on customer centricity and the quality of service rendered to the member within the scheme's benefit design.

Requirements    
WHAT YOU'LL NEED:

• Registered Nurse with Degree or Diploma (General, Psychiatric and Midwife).
• Current registration with the SANC, on application.
• Diploma in Theatre Technique or ICU (or minimum 3 years relevant experience)
• RPL course would be an advantage
• At least 5 years post graduate clinical experience
• At least 3 years Managed Care/Medical Aid industry experience  
• Strong knowledge of PMB legislation, Clinical Coding (ICD 10 , CPT & NHRPL), hospital and doctor’s billing guidelines  is highly advantageous
• Strong Oracle system knowledge and CARM rules is an advantage

Duties & Responsibilities    
WHAT YOU'RE GOING TO DO

• Review specific hospital claims for clinically appropriateness, treatment received, over usage of equipment / materials and consistency with billing rules;
• Apply scheme rules, clinical policies and protocols;
• Liaise with the medical advisor if necessary;
• Review and maintain clinical auditing rules (CARM) annually;
• Review hospital network billing guidelines annually and feedback to the business;
• To identify hospital trends and claiming patterns with the objective of changing provider behaviour and giving continuous feedback to the business;
• Clinical support to provider network team and discussing identified trends to provider team;
• Attend quarterly HRM operational meetings and feedback regarding trends and application of billing guidelines;
• Action clinical auditing work and volumes timeously and within set service level agreement;
• Assist with auth-claim matching queries
• Ensure accurate savings is recorded according to pay codes and reason codes; reviewing automated monthly savings report;

Competencies    
WHAT COMPETENCIES YOU'LL REQUIRE

• Excellent problem solving skills
• Accurate and vigilant
• Target oriented
• Ability to work under pressure and meet deadlines
• Analytical thinking and investigative mind
• Conceptual thinking
• Attention to Details
• Self-Motivation
• Teamwork focused
• Analytical Thinking
• Good time management skills
• Quality orientated
• Trend management focus
• The ability to apply, maintain and expand professional and technical knowledge in order to deliver a better service to customers and improve performance, including sharing knowledge and experience with others
• Excellent verbal Communication

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Role Purpose    

• To partner proactively and constructively with the Compliance community across the group to facilitate the achievement of Risk and Compliance objectives and to provide ongoing guidance and oversight where needed.  The role also involves liaison with the regulators on approvals, notifications, statutory reporting and query resolution and supporting group functions that do not have dedicated Compliance support.

Requirements    

• 8-10 Years compliance related experience in the insurance and financial services industry*
• Degree Risk Management|Bachelors qualification in Law/Commerce|Post graduate qualification in Compliance Management
• Be registered as a licensed compliance officer with the FSCA
• Understanding of the insurance and financial services industry       
•  Knowledge and understanding of the typical products offered by organisation 

General (pre-requisite):

• Superb abilities to lead through influence and build relationships at all levels
• Excellent written and verbal communication, reporting and presentation skills
• Assertive, resilient and able to work under pressure
• Good internal consulting, coaching and mentoring skills
• Analytical and attentive to detail
• Deadline and solution-driven

Technical Pre-requisite:

• Displays strong understanding of Compliance management frameworks, methodologies, processes and industry best practices 
• Functions proactively and strategically with a holistic view on Compliance
• Able to advise business on complex compliance matters
• Displays deep understanding of relevant legislation and its impact on business strategy
• Able to write, communicate and interpret legislative requirements at the appropriate level (including translating technical legal knowledge for a non-legal audience)
• Relevant systems knowledge

Organisation (induction):

• Sound understanding of MMH’s vision, values, mission and culture
• Expressed and implied ethical responsibilities
• Sound understanding of the group structure and business flows

Role (foundational knowledge):

• Compliance policies, frameworks, methodologies and practices
• MMH’s reporting structure
• Business strategy
• Displays a sound understanding of the regulatory universe and how it applies to different businesses
• Understanding of broader Risk framework and how individual legal risk elements are managed
• Strong focus on building a sound internal and external network

Changing knowledge requirements:

• Regulatory changes
• Evolving control framework
• Business structure and reporting lines
• Business strategy and priorities
• Industry best practice in all areas relevant to the role
• Evolving technology and system changes
• Reporting requirements

Compliance Requirements:

• Internal Codes of Conduct, standards, policies and procedures
• Knowledge of regulatory requirements and changes thereto (e.g. LTIA, STIA (including the PPR’s), Insurance Act & the Prudential Standards (GOI’s, GOG’s, FSI’s, FSG’s), FSRA, Pension Funds Act, Companies Act, FAIS, FICA, CISCA, POPIA, CoFI, FSCR, etc)

Duties & Responsibilities     
INTERNAL PROCESS...

• Company - wide Compliance monitoring and reporting:
• Approved MCP (monitoring coverage plan)
• Achievement of group compliance objectives
• Prompt flagging and management of potential risks (including consequence management)
• No reporting breaches

Satisfactory audits

• Accurate and up-to-date bank of regulations stored and maintained in the regulatory universe
• Accurate, timely updated Compliance documentation 
• Professional advice, guidance and training to the group on Compliance matters:
• Clear and structured communication and advice to business
• Strong business partnerships evidenced by internal stakeholders seeking advice and off-the-record opinions
• Foll0w-through on identified training needs

Satisfactory audits resulting from raised awareness

• Improved Compliance capabilities
• Compliance support to the international businesses:
• Achievement of cross-border compliance objectives
• Achievement of project objectives
• Satisfactory audits
• Formal and ad hoc project management:
• Achievement of project objectives
• External stakeholder engagement and reporting:
• Strong relationships with the regulators that facilitate the achievement of business goals
• No breaches, fines of penalties
• Proactive risk mitigation
• Internal stakeholder engagement and reporting:
• Strong business partnerships
• Stakeholder satisfaction
• Team leadership and mentoring of Compliance Interns:
• Interns are supported to achieve their objectives

Cost consciousness:

• Enhanced efficiencies
• Proactive risk mitigation
• Effective teamwork, self-management and alignment with MMH values:
• Achieves results through strong business partnerships
• Stakeholder satisfaction
• Adherence to procedures and ethical standards

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Role Purpose    

• Coordinate and promote patient care between multiple service providers to ensure effective treatment plans with the objective of containing associated costs generated by these services.

Requirements    

• National Senior Certificate is essential
• It is essential to have a Nursing Diploma or Degree
• Postgraduate qualification in Primary Health Care would be beneficial
• The incumbent must be registered with SANC (South African Nursing Council) as a Registered Nurse
• Minimum of 2-3 years’ experience in a private hospital is essential
• A minimum of 1 years’ experience in an ICU would be an advantage
• Experience in Managed Health Care is highly advantageous
• Good understanding of the medical aid industry i.e. trends, competitors, legislation is preferred
• MS Office proficiency
• Language proficiency in Setswana is advantageous
• The incumbent must have their own insured vehicle and valid driving licence

Duties & Responsibilities    

• Create individualised optimal care plan in coordination with the patient, primary care provider and family/caregiver(s)
• Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals
• Increase patients’ ability for self-management and shared decision-making
• Provide medication reconciliation to eliminate medication errors and to ensure compliance.
• Connect patients to relevant community resources, with the goal of enhancing health and well-being, increasing patient satisfaction and reducing health care cost
• Serve as the contact point, advocate and informational resource for patients, care team, family/caregiver(s), payers and community resources
• Create ongoing processes for patient and providers to determine the level of care coordination support they desire at any given point in time
• Facilitate patient access to appropriate medical and specialty providers
• Facilitate and attend meetings between patient, family/caregiver(s), care team, payers and community resources, where needed
• Assist with the identification of possible “high-risk” patients in hospital
• Provide feedback and reporting for the improvement of the Care Coordination Program
• Identify trends, analyse where necessary and make improvement suggestions

Competencies    

• Excellent communication skills – verbal and written
• Accountability
• Planning and organising
• Problem solving
• Time management
• Attention to detail
• Interpersonal skills 
• Customer orientation
• Results driven
• Empathetic nature 
• Team player
• Ability to work independently

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Role Purpose    

• Educate employers, financial advisors and members on their group benefits to promote product utilization, understanding of benefits as well as promote and educate stakeholders (internal and external) regarding availability of digital platforms that the company provides.

Requirements    

• Grade 12
• NQF 6 or equivalent qualification in long term insurance
• At least 3 years relevant experience in an Employee Benefits environment
• Intermediate excel with capabilities in v-lookup and pivot functions
• Experience in presenting to large client or member group
• Ability to speak an African language, Zulu being advantageous

Additional Information

• Willingness to travel frequently (between 1 to 5 days)
• Valid driver's licence and vehicle
• Willingness to use own vehicle to travel and claim back travel costs according to the Momentum Metropolitan Life Limited Travel policy

Duties & Responsibilities    

• Prepare, present and educate employers and members on their products and benefits to ensure clear understanding and website usability.
• Assess client profile and needs with the intention to pair relevant digital solutions suited for the client.
• Monitor trends in client experience, expectations and give feedback on ways to improve operational efficiencies to support the Momentum Metropolitan Life Limited business.
• Maintain broad industry, product and process knowledge in order to effectively and accurately assist clients and members with their training needs and queries.
• Create and build relationships with the internal stakeholders to ensure effective operational servicing.
• Actively promote new business initiatives and strategies to create a positive and value based client experience.
• Identify and recommend system and process enhancements enabling client satisfaction and retention.
• Escalate any unresolved client, sales or training issues or queries to ensure quick resolution.
• Take full accountability and responsibility for clients queries related to the Client Education function.

Competencies    

• Communicating with impact
• Client orientation
• Organised
• Attention to detail
• Teamwork and cooperation
• Presentation skills
• Results orientated
• Decision making and problem solving skills

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Role Purpose    

• To provide an effective and efficient administrative and operational assistant function to support the division and manager.

Requirements    

• Matric is essential(With Biology is preferred)
• 1 -2 years Call Centre experience is essential
• Medical Claims Assessing Course Certification is an added advantage
• Experience in Chronic Disease Management and Oncology queries would be an advantage
• Relevant Managed Healthcare experience is essential
• Experience in Word, Excel, PowerPoint and Outlook

Duties & Responsibilities    
What you're going to do

• Pro-actively screen incoming calls, correspondence and respond independently where possible.
• Collaborate in supporting two-way communication between various internal and external stakeholder.
• Perform an efficient and accurate administrative function
• Deliver and/ or collect documentation or persons, according to instructions
• Set-up and provide refreshments for meetings and/or presentations
• Provide an efficient and accurate message taking function
• Identify and escalate priority issues
• Support with the managing of calendars and effectively schedule appointments
• Deal promptly with client requests in a competent, efficient and professional manner
• Drive and support effective teamwork within the department
• Engage in appropriate training interventions to promote own professional development
• Ensure to demonstrate the company's values on a daily basis
• Participation in the planning and logistics of events / project relating to the department
• Assist with general administration functions relation to the broader Operations department

Competencies    
What competencies you'll require

• Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
• Anticipates, meets and exceeds client's needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
• Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
• Actively leads change, does what is right for the business and drives continuous improvement through innovation.
• Creates and maintains an open, positive working environment by generating commitment, building trust, a shared sense of purpose, empowerment in others and encouraging them to contribute to the best of their ability.
• Prioritises the business interests of MMI and invests in the success of the group by aligning effort across divisions.
• Persuades, convinces, influences and inspires others, both within MMI and externally to win support, loyalty and gain commitment to the purpose of MMI.
• Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
• Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
• Takes responsibility for own development; and actively mentors, coaches and develops talent in others. Builds leadership bench strength for MMI by providing opportunities and experiences to develop skills, competencies and business knowledge.

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Role Purpose    

• Momentum Insure is a registered Financial Services Provider. We provide the full range of personal and commercial short-term insurance products and deal exclusively through registered intermediaries.

Requirements    

• Minimum matric or equivalent
• FAIS accreditation will be higly advantageous 
• Previous call centre experience preferably in a client centric or sales environment will be advantageous

Duties & Responsibilities    

• The Lead Converter will be responsible to validate leads and confirm if client is interested in a quote Confirmed leads will be loaded and allocated to a sales consultant to quote and close loading of messages

Competencies    

• Client service oriented
• Attention to detail/Quality oriented
• Deadline and results oriented/Work standards
• Enthusiastic and passionate about the job and the company
• Effective at planning and organisation/Work management 
• Teamwork/Collaboration
• Judgment/Problem solving
• Adaptability
• Integrity
• Tolerance for stress
• Interpersonal and communication skills
• Negotiations
• Keyboard skills
• Administration skills
• Influencing
• Practical learning
• Computer literacy

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Role Purpose    

• The Clinical Risk Manager will act as a trusted advisor, collaborating with clients to improve health outcomes, reduce risk and ensure that services align with business priorities and client needs.

Requirements    

• National Senior Certificate
• The incumbent must have a degree in the field of health (e.g. B.Pharm, BCur)
• A postgraduate leadership qualification would be highly advantageous
• Must be registered with the relevant regulatory body determined by the qualification
• 5 Years' working experience in a managed care environment in a senior operational, managerial or strategic role
• 2 Years' experience in a client facing role
• Knowledge of healthcare industry legislation, trends and competitors
• Knowledge of healthcare management and managed care practices
• Understanding of medical scheme industry rules, regulations and benefit structures
• Must be in possession of a valid driver's licence and own insured vehicle

Duties & Responsibilities    
PROCESS

• Foster a strong innovation focus within our Health Risk Management offering to drive continuous improvement and stay ahead in the industry.
• Provide meaningful and relevant appropriate reporting on Health Risk Management functions and trends to enable informed decision-making and proactive risk management.
• Ensure accurate reporting on all strategic, operational and contractual requirements to maintain transparency and accountability.
• Act as the custodian of the Health Risk Management escalation matrix to facilitate efficient issue resolution and escalation processes.
• Inspire collaboration within the Health Risk Management Team and wider business unit to foster a culture of teamwork and knowledge-sharing.
• Assist and support the Head of Operations and Head of HRM strategy in meeting the business needs of clients by aligning strategies and actions accordingly.
• Facilitate the proficient implementation of the Health Risk Management and products strategy to drive successful outcomes.
• Oversee the Managed Care admin interface to ensure the successful application of program specifications throughout the value chain.
• Take accountability for all audit and risk management requirements, ensuring compliance and minimising risk exposure.
• Provide clinical input and assistance as needed in the business to ensure quality and effectiveness.
• Facilitate the adoption of various forms of technology to drive the achievement of beneficiary wellbeing and good clinical outcomes.

CLIENT

• Continuously monitor turnaround times and quality standards, resolving issues promptly to enhance client service delivery and satisfaction.
• Drive the achievement of client service delivery goals in line with predefined standards, ensuring clients receive appropriate advice and exceptional after-sales service.
• Manage client query processes, accurately track and resolve queries, and utilize them as a mechanism to improve client service and streamline business processes.
• Provide risk management expertise and advice to clients and stakeholders, ensuring effective risk mitigation and compliance.
• Build and maintain strong relationships with clients and internal and external stakeholders to foster collaboration and mutual success.
• Contribute to the process of negotiating objective and realistic service level agreements, monitor their appropriateness and recommend adjustments to enhance client satisfaction.
• Make recommendations to improve client services and promote fair treatment of clients within the area of responsibility, ensuring high levels of client satisfaction.
• Actively participate and contribute to a culture that builds rewarding relationships, facilitates feedback and consistently delivers exceptional client service.

PEOPLE

• Create a positive work climate and culture to energise employees, give meaning to their work, minimise work disruption and maximise employee productivity.
• Demonstrate exemplary leadership behaviour through personal involvement, commitment and dedication in support of organisational values.
• Drive a culture that guides and directs best practices, fostering an environment of continuous learning, improvement and cohesiveness.
• Enable a learning and growth culture where information regarding successes, issues, trends and ideas is actively shared between team members, promoting collaboration and innovation.

FINANCE

• Implement and manage financial risk methodologies, techniques and systems to effectively monitor and report on financial activities.
• Implement and provide feedback on the effectiveness of financial policy, practice and procedures preventing illegal, unethical or improper conduct.
• Implement risk management, governance and compliance policies in own practice area to identify and manage governance and risk exposure liability.
• Investigate reported wilful acts of non-compliance to organisational policy and practice and report on findings to ensure adherence to compliance standards.

Competencies    

• Collaboration
• Business acumen skills 
• Client relation skills 
• Change management skills
• Innovation skills
• Report writing skills
• Strategic thinking
• Influencing skills
• Customer relationship management
• Strategy translation skills  

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Role Purpose    

• To liaise between Momentum Health Solutions and MDS to ensure there is a good working relationship at all levels.

Requirements    

• Matric/ Grade 12
• Relevant Qualification (Added Advantage)
• 5 Year's experience in the Health Industry

Sales experience

Duties & Responsibilities    

• Liaise between Momentum Health Solutions and MDS to ensure there is a good working relationship at all levels
• Attend MDS Exco on a monthly basis
• Position and help steer the health strategy within MDS
• Meet with the various stakeholders within MDS to ensure alignment between MHS and MDS
• Discuss and drive relevant activities towards achieving the set health targets with all MDS regions on a regular basis
• Ensure health targets are met and help to set new targets each year
• Co-ordinate regular service meetings between relevant areas
• Support and manage the MDS BDMs
• Facilitate Thought Management sessions for selected advisors quarterly
• Manage the Health Master Classes and other training requirements
• Meet with Key MDS advisors
• Keep MDS informed of relevant product house changes
• Keep MDS informed of relevant health industry changes
• Manage new segmentation model and relevant incentives for MDS

Competencies    

• Providing Insight
• Developing Strategies
• Decision Making
• Generating Ideas
• Empowering Individuals
• Exploring Possibilities
• Directing People
• High level strategic thinking