Job Description

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

Assist and provide consultancy input to the Business analysts with development in regard to new projects, take ons migrations and enhancements to the system including all provider networks and schemes.

Requirements

A Business, Information Technology, Finance or equivalent degree.
Minimum 5 years of working within a medical aid industry.
Minimum 5 years of Oracle system.
Understanding of medical legislation, council for medical schemes/HPCSA/ BHF function.
Sound knowledge of medical aid tariffs, disciplines, subcategories, modifiers.
Sound knowledge of CPT , ICD 10 and PMB.
B2B understanding and processing and internal business protocols.
Excel and word proficient.

Duties & Responsibilities

Provide input from a provider/system perspective, into the yearend process, take ons, migrations, new projects and any third party interfaces.
Investigate escalated system issues from third parties, master files, funds and business units, and provides solutions.
Escalation point for the IT for system failures ,file failures related to healthcare providers.
Understanding BHF data files for industry data transfer.
Assists with the creation of rules and process to align tariffs to the relevant providers/disciplines to facilitate accurate payment of claims.
Investigate escalations with regards to provider ERAs.
Updating of 3rd party data files onto operating system.
Alignment of Provider networks to web and digital interfaces via our IT AND Webteams.
Logging changes for ICD10 and CPT.
Specify and drive the creation of operational reports with BI for provider operational needs.
Provider Engagement escalation point for the Oracle internal operational staff.
Technical and operation support to the Provider Relations team.
Handling and analysis of exception reports based on 3rd party information loaded on system VIA ftp sites.
Operational and process input for the initial system set up for new schemes and options.
Build and maintain relationships with clients and stakeholders that promote cross delivery practice solutions.
Contribute to sustaining a competitive edge through external networking and benchmarking and representation on related forums.
Define fair and innovative client service practices which build rewarding relationships, and allows team to provide exceptional client service.
Monitor IT Requests and projects to achieve efficient outputs.
Prioritize and drive provider IT requests in the company by analysing, documenting and presenting the business impact.
Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.
Provide regular reports on delivery of services against agreed service level agreements and in terms of overall client targets.
Provide authoritative, expertise and advice to clients and stakeholders in relations to technical and escalation enquiries.
Build and maintain relationships with clients and internal and external stakeholders.
Contribute to the process enhancements and recommend adjustments to increase the Provider Team efficiency in relation to SLA'S.
Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
Make recommendations to improve client service and fair treatment of clients within area of responsibility.
Participate and contribute to a culture which builds rewarding relationships, facilitates feedback.
Provide exceptional client service to providers.
Develop and maintain productive and collaborative working relationships with peers and stakeholders.
Positively influence and participate in change initiatives.
Continuously develop own expertise in terms of professional, industry and legislation knowledge.
Contribute to continuous innovation through the development, sharing and implementation of new ideas.
Take ownership for driving career development.
Manage financial and other company resources under your control with due respect.

Competencies

Strong analytic skills to perform root cause analysis of system issues experienced by providers.
Understanding of switching processes and real time claiming.
Able to read and understand file formats for data transfer.
Able to make quick decisions during crises situations.
Must be able to work under pressure and meet deadlines.
Sound information technology understanding.
Structured.
Solution orientated.
Team player.
Technical mindset.
Excellent communication skills.
Excellent client service (delivery).
* Innovative.