Rand Water Medical Scheme Supervisor - M Band - Jobs in South Africa

Job Advert Summary

Rand Water is looking for a Medical Scheme Supervisor who will have the responsibility of managing the daily operational requirements of the Rand Water Medical Scheme including staff supervision.

The position will be based in Rietvlei.

Minimum Requirements

• B Cur Nursing Degree or Diploma in General Nursing with (Midwifery, Community Health and or Psychiatric Nursing) or Diploma in General Nursing;

• 5 years medical scheme administration experience with at least 3 years in administration;

• Minimum of 3 years’ supervisory experience;

• Sound knowledge of the Medical Schemes Act No 131 of 1998 and its Regulations;

• Excellent interpersonal skills and the ability to interact at all levels with members, trustees and service providers;

• Computer literacy (MS Office Suite; with sound knowledge of various (IP) i.e. Medical Scheme IT Administration Systems.

Primary Duties

• Ensuring that all levels of the procedures comply with Medical Schemes Act No 131 of 1998 and its Regulations;

• Responsible for the administration of claims and membership business process management system;

• Ensure the provision of excellent high quality customer service to clients and service providers;

• Ensure the updating of the relevant clinical policies and procedures; evaluate requirements for system enhancements and technical configuration for compliance with legislation;

•

Be proactive in implementing relevant clinical changes to the Rand Water Medical Scheme within medical scheme industry;

• Responsible for compiling monthly operational reports;

• To remain abreast with relevant changes within the medical scheme industry such as National Health Insurance (NHI) Board of Healthcare Funders (BHF), Council for Medical Schemes (CMS), Third Party Recoveries, and POPI Act.
Knowledge

Strong Clinical Medical Scheme background/knowledge

• A sound knowledge of the Medical Schemes Act No 131 of 1998 and its Regulation other related Health Legislation (POPI, NHI)

• Sound knowledge of NRPL , ICD 10 coding, PMB’s and clinical coding & protocols ,

• Computer literacy(MS Office Suite & various medical scheme IT Admin system

• Accounting knowledge and Accounting Systems

Skills

• Good interpersonal skills

• Strong communication (written & verbal)

• Supervisory skills

• Ability to interact at all levels

• Problem solving

• Negotiation

• Planning and organising

• Report Writing

• Conflict Management skills

Attitude

• Accuracy & Attention to detail

• Time Management

• Deadline orientated

• Self-motivation

• Analytical thinker

• Customer focussed

• Confidentiality, Integrity & Honesty

• Ability to work under pressure

• Innovative and Creative

• Professional Integrity

• Self-Driven with results

How to Apply

For more information and job application details, see; Rand Water Medical Scheme Supervisor - M Band - Jobs in South Africa

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