Job Vacancies at Discovery Limited

Key Purpose:

 

• Managing the risk relating to in hospital admissions, through the application of clinical and coding knowledge and aligning to protocols, legislation, standard operating procedures (SOP’s), service level agreements (SLA’s) and the member’s benefit structure. The role will apply to working in various settings, predominantly casualty. It is anticipated that the risk purpose will also extend into the general ward and high care/ICU settings as needed.
• Coordinating the care of certain patients who are vulnerable to care gaps during transitions particularly entry into hospital through to the emergency room, and discharge from hospital. The populations most vulnerable to gaps in care during transitions include clinically high risk patients; patients undergoing major surgical procedures; and patients with low socio-economic circumstances.

Please note: The successful applicants will be based at a designated hospital within the applicable region.
Key Outputs
The successful applicant will be responsible for but not limited to the following job functions:
Assessing the case in relation to the following:

• Members clinical history
• Members benefit structure
• Clinical Information and coding supplied
• Level of care provided
• Appropriateness of the facility
• Appropriateness of the treating doctor
• Appropriateness of treatment
• Managing the benefit for the member and the risk for the relevant scheme through a thorough process to approve or decline Funding to ensure that the member gets the appropriate level of care
• Discharge planning by providing the member with alternatives to receive treatment ( This includes Hospital @ Home, Homecare etc.)
• Effective and accurate communication to all stakeholders:
• Case update to the provider
• Funding decisions and benefit confirmation to the members
• Request for additional information from the treating doctor or practice manager
• Engaging with Patient Services Manager and hospital staff
• Handling escalations from Providers and internal stakeholders
• Preparing and presenting complex case to clinical review
• Trend Analysis of inefficiencies and proposals to correct
• Appropriate internal case referrals for clinical management

Operational Targets:

• Attend to patieon survey

Personal Attributes:

• Emotional Intelligence - Ability to understand, use, and manage emotions in positive ways to communicate effectively, empathise with others and defuse conflict.
• Composure - Is cool under pressure; does not become defensive or irritated when times are tough; is considered mature; can be counted on to hold things together during tough times; can handle stress; is not knocked off balance by the unexpected; doesn't show frustration when resisted or blocked; is a settling influence in a crisis.
• Conflict Management - Steps up to conflicts, seeing them as opportunities; reads situations quickly; good at focused listening; can hammer out tough agreements and settle disputes equitably; can find common ground and get cooperation with minimum noise.
• Decision Quality – Makes good decisions (without considering how much time it takes) based upon a mixture of analysis, wisdom, experience, and judgment; most of his/her solutions and suggestions turn out to be correct and accurate when judged over time; sought out by others for advice and solutions.
• Integrity and Trust - Is widely trusted; is seen as a direct, truthful individual; can present the unvarnished truth in an appropriate and helpful manner; keeps confidences; admits mistakes; doesn't misrepresent him/herself for personal gain.
• Negotiating - Can negotiate skillfully in tough situations with both internal and external groups; can settle differences with minimum noise; can win concessions without damaging relationships; can be both direct and forceful as well as diplomatic; gains trust quickly of other parties to the negotiations; has a good sense of timing.
• Perseverance - Pursues everything with energy, drive, and a need to finish; seldom gives up before finishing, especially in the face of resistance or setbacks.
• Problem Solving - Uses rigorous logic and methods to solve difficult problems with effective solutions; probes all fruitful sources for answers; can see hidden problems; is excellent at honest analysis; looks beyond the obvious and doesn't stop at the first answers.

Education and Experience:
The following requirements are essential:

• Matric
• Must be a Registered Nurse
• Valid SANC Registration
• 3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable)
• 2 years Managed health care experience 
• Microsoft Office (Specifically Excel experience)
• Valid Driver’s License and own transport
• Effective Communication Skills (Verbal & Written)
• Telephone Etiquette
• Active Listening Skills

The following requirements will be advantageous:

 

• 1 – 2 years ICU experience
• Knowledge of DH SOP’s and Process experience (internal only)
• Provider payment arrangements (internal Only)
• Clinical coding knowledge of ICD-10 and/or CCSA

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Key Purpose

• The Agile Programme Manager will be responsible for the end-to-end Project/Programme Management Delivery which includes the support of project/programme management related processes, standards, policies and methodologies. Performs the duties of a scrum master, including but not limited to agile planning, agile organizing, facilitating stand-ups and managing of resources to bring about the successful completion of tasks, projects and programmes. Manages the sequence of activities in an agile manner and allocates resources to complete the project & programme life cycle. Has the authority, accountability and responsibility for managing projects and programs to achieve the business vision and objectives. Acts as an evangelist of the discipline, using opportunities to promote the benefit of a structured & organised approach to change and coordinated effort.
• This role, agile Programme Manager plays a major role in building relationships with the client, team and business. You will be an effective advocate of the market facing team in the project and programme development lifecycle and will interface with several teams, Business Analysts, Developers, Testers, Actuaries, Product Specialists, development teams locally and abroad (different time zones), testing teams, executives and most importantly the client to implement initiatives that support and drive engagement in the Vitality wellness program. The incumbent will spend 70% of their time on Programme Management duties, and 30% on Scrum Mastering duties (70/30 split). It is therefore vital for the incumbent to have experiences on both.

Areas of responsibility may include but not limited to:
Interaction with People:

• Understand, interpret and translate strategic objectives into projects with measurable outcomes
• Managing the day-to-day operations of the project management team by providing hands-on approach across projects and programmes
• Plan, allocate, organize and control tasks and projects to the Project Management team
• Train and coach project leaders and stakeholders on the project management process, related principles and methods
• Provide mentorship regarding best practices for project management and programme management
• Interact with business stakeholders at all levels of the organization

Documentation:

• Create agile project plans
• Document, update and communicate weekly and monthly progress updates
• Document, update and communicate project risks and mitigations
• Document and communicate lessons learned
• Create a standard set of principles and methods, practices, and templates for managing various projects across the business

Process:

• Lead agile activities
• Produce estimates for proposed work to inform enhancement costs
• Perform risk analysis on proposed development initiatives
• Identify and drive process or other solutions to improve business results, product performance and client satisfaction
• Employ critical thinking and problem-solving skills during planning & execution of solutions

Technology:

• MS Project
• MS PowerPoint
• MS Excel
• MS Word

Project knowledge:

• Getting things done and delivering on the quadruple constraints (Scope, time, budget, and Budget)
• Coordinate projects with business, Product Analysts, Actuaries, Business Analysts, Project managers, stakeholders and technical resources
• Understand project plans and milestones
• Help identify dependencies on projects as part of project planning and delivery
• Involved in project estimation processes, planning, execution and testing
• Creative thinker who comes to the table with alternative solutions when first-ask options prove to be too costly or complex.
• Review the project schedule with senior management and all other staff that will be affected by the project activities; revise the schedule as required
• Determine the objectives and measures upon which the project will be evaluated at its completion
• Establish a communication schedule to update stakeholders including appropriate staff in the organization on the progress of the project
• Ensure that all project personnel receive an appropriate orientation to the organization and the project
• Contract qualified consultants to work on the project as appropriate
• Execute the project according to the project plan
• Monitor the progress of the project and adjust as and when necessary to ensure successful completion of the project
• Review the quality of the work completed with the project team on a regular basis to ensure that it meets the project standards
• Ensure that the project deliverables are executed on time, within budget and at the required level of quality
• Monitor and approve all budgeted project expenditures
• Manage all project funds according to established accounting policies and procedures
• Evaluate the outcomes of the project as established during the planning phase

Key skills and expectations:

• Be optimistic, outgoing, confident, curious and self-driven
• On time delivery with rigorous attention to detail is a must
• Facilitates stand-ups and project meetings
• Manage multiple concurrent tasks, projects and programmes
• Gathers requirements from business on big and small projects
• Drafts and gets Risk registers and Risk mitigations
• Ability to use JIRA
• Drives, oversees and reviews post project reviews
• Produce an accurate Project/Programme plan from all stakeholders
• Accurately document actions, decisions, issues and risks clearly defining project objectives
• Presentations and walk-through discussion. Obtain sign-off on documents
• Perform project estimation for BA tasks
• Make recommendations to client on projects and programmes
• Present to senior stakeholders and team

Personal Attributes and Skills
Personal Attributes or Competency Profile

Discovery Person

Values Driven:

• Committed to integrity and ethics in business
• Behaves consistently with Discovery Values

Optimistic:

• Motivated by a positive future
• Energised by challenges

Learns on the Fly:

• Embraces the unfamiliar
• Experiments to find solutions

Resilient:

• Recovers quickly from setbacks
• Grows from negative experiences

Instils trust:

• Follows through on commitments

People Savvy:

• High EQ with low ego

Drives Results:

• Energises self and others to achieve
• Consistently exceeds goals

Problem Solver:

• Looks beyond the obvious
• Finds sustainable solutions
• Process and customer experience focus
• Risk Mitigation
• Solutions driven

Education & Experience
Education

Education / Qualifications / Accreditations with Professional Body

Required

• Matric
• NQF Level 7: Relevant Bachelor’s Degree (Preferably in Project and Programme Management)

Technical Required

• Planning and Execution
• Business writing skills
• Communication (Presentation and facilitation skills)
• Stakeholder management
• Jira
• Scrum master skills

Preferred (would be advantageous)

• Process
• Project Coordinator/Administrator

Work Experience

Work Experience

• At least 7 years’ experience in a Project Management role
• Minimum 5 years’ experience in a Programme Management role
• At least 2 years’ experience as a Project Coordinator/Administrator
• Sound experience in applying and implementing project management methodologies.

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Key Purpose

• Provide continuous monitoring and support of Linux environments.  Design and implement containerized solutions for machine learning models. Technical leadership and ownership of Linux environments.

Areas of responsibility may include but not limited to:

• Administration & continuous monitoring of Linux environments
• Optimize machine learning models & solutions produced by Data Scientists & Actuaries
• Participate in the architecture of ML environments and frameworks
• Provide ongoing support and enhancement to ML models
• Estimate time and resource requirements for business requirement
• Container management and automation
• Implement Redhat/Linux best practice and standards
• Conduct root cause analysis on production issues
• Technical leadership of entire information management process of both structured and unstructured data
• Implementing machine learning algorithms in production through integration
• Configuration of the Big Data infrastructure and environment for optimal performance
• Work closely with Data Scientists & Actuaries in productionisation of ML model
• Producing relevant technical documentation and specifications
• Develop data processing functions (DPF’s) using Java or Python, etc.

Education and Experience

• Matric    (Essential)
• Minimum 3 – 5 years’ experience
• Redhat certification (Advantageous)
• National Diploma in IT (BTech) or appropriate certification (Advantageous)
• Bachelor of Science (Information Systems, Computer Science, Mathematics) Advantageous
• Linux administration (Intermediate) 
• Linux Shell Scripting (Intermediate)
• Distributed programming skills on a cluster environment (Intermediate)
• Container setup (e.g., Docker) (Intermediate)
• Python/R/Scala Programming (Intermediate)
• Git versioning
• Spark Configuration (Intermediate)
• CI/CD
• Systems Development Life Cycle (SDLC) (Intermediate)
• Data Security and Protection Policies (Intermediate)
• Big Data using Hadoop (Intermediate)
• SQL (Basic)
• Java/.net Programming (Advantageous)
• Big Data Ingestion using Sqoop/Kafka (Advantageous)
• MS Excel (Basic)

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Key Purpose

• To investigate and validate non-motor claims to determine validity based on the Discovery Insure contract. To correctly quantify and validate losses and serve as a mediator between clients and/or brokers. Provide feedback and support to claims consultants and foster good relationships between brokers and clients.

Areas of responsibility may include but not limited to

• Non-motor claims investigation and validation, including settlement, rejection and repair within service level agreement.
• Turn-around time and predetermined mandates.
• Loss adjustment by correctly quantifying losses and/or verifying claimed amounts. Mediation between Insure client and/or broker.
• Reporting on all assessed claims and making recommendations.
• Analyse client behaviour to determine legitimacy of claims.
• Investigate and report on fraudulent claims.
• Perform administrative tasks and meet strict deadlines.
• Make recommendations to prevent fraud.
• Analyse, collecting, evaluating and handling of evidence.
• Claims forum presenting of claims.

Education and Experience

• Matric (Essential)
• 5 years’ minimum short term insurance claims experience (Essential)
• 5 years’ short-term insurance non-motor claims validations and investigations experience (Essential)
• Interviewing techniques (Essential)
• Investigation terminology (Essential)
• Tertiary qualification relating to investigations and interviewing e.g. Certified Fraud Examiner (Advantageous)
• Hold a valid driver licence
• Willing to travel