Job summary To assist Top Management and Management in discharging their responsibility to comply with applicable regulatory requirements through the provision of compliance risk management services. To oversee the Corporate Compliance Program that reviews and evaluates all compliance issues/concerns within Bestmed. To take responsibility for identification, assessment, management, monitoring and reporting of any compliance risks faced by Bestmed by means of the Corporate Risk Register. To provide litigation services on behalf of the scheme. Assist with policy development in line with legislation. Duties & Responsibilities The role and responsibilities of the Executive: Legal, Risk and Governance include the following, but are not limited to: Strategic and Governance Responsibilities Assist in the development and execution of the overall organisational strategy. Work closely with the Board of Trustees (BOT) and Executive Management to define and support Legal, Risk and Governance requirements. Compile, implement, and manage the Legal, Risk and Governance strategy and frameworks. Ensure compliance with King IV principles and other applicable governance standards. Ensure that BOT and Sub-Committee requirements are implemented across the Scheme. Monitor governance processes and resolve related issues where required. Prepare reports for the BOT and relevant Committees on legal, compliance, governance, and risk matters. Manage and maintain Bestmed Scheme rules – including securing approval from CMS. Legal Advisory and Litigation Management Provide legal opinions and guidance to the BOT and Executive Management to support informed decision-making. Review, draft, negotiate, and manage contracts, service level agreements, and related legal documentation. Identify and advise management on legal risks and mitigation measures. Provide first-line legal support for disputes and litigation matters. Monitor and manage litigation processes in conjunction with management and external attorneys. Represent Bestmed at CMS appeal hearings and other relevant forums or proceedings. Interpret legislation, rulings, regulations, and industry developments, and assess their impact on the Scheme. Manage the Scheme’s Intellectual Property portfolio, including renewals, registrations, disputes, and liaison with appointed IP attorneys. Compliance and Risk Management Oversee and maintain the Corporate Compliance Programme. Identify, assess, monitor, manage, and report on regulatory compliance risks. Maintain and update the Corporate Risk Register and provide regular reporting thereon. Verify that policies, procedures, and operational practices comply with legislative and regulatory requirements. Maintain and review the Compliance Charter and related compliance frameworks. Develop, maintain, and monitor compliance dashboards, standards of conduct, and ethical governance initiatives. Formulate compliance checklists for high-risk areas. Conduct or oversee compliance investigations and maintain records of complaints and investigation outcomes. Report material compliance breaches or regulatory violations to relevant internal and external stakeholders where required. Fraud, Waste and Abuse Management Develop, implement, and oversee the Scheme’s Fraud, Waste and Abuse (FWA) governance framework and related control measures. Identify, assess, monitor, and report on fraud, waste and abuse risks across the Scheme. Ensure appropriate preventative, detective, and corrective controls are implemented to mitigate FWA risks. Oversee the investigation and management of suspected fraud, waste and abuse incidents in collaboration with internal stakeholders, forensic specialists, and external service providers where required. Monitor trends, emerging risks, and industry developments relating to fraud, waste and abuse within the healthcare funding environment. Provide guidance and recommendations to Management, Committees, and the Board of Trustees on FWA-related matters and mitigation strategies. Ensure appropriate reporting, record-keeping, and escalation of material FWA matters in line with regulatory and governance requirements. Promote awareness and a culture of ethical conduct through training, communication, and awareness initiatives related to fraud prevention and reporting obligations. Liaise with regulatory bodies, industry forums, law enforcement agencies, and other relevant stakeholders on FWA matters where required. Ensure that fraud prevention and ethical conduct principles are embedded within policies, procedures, and operational processes across the Scheme. Policy, Training and Stakeholder Support Assist with the development, review, implementation, and communication of policies and procedures aligned to legislative requirements. Communicate and facilitate compliance-related guidance and training across the Scheme. Facilitate regular compliance meetings with compliance representatives across the organisation. Serve as a confidential point of contact for employees seeking guidance on compliance or ethical matters. Build and maintain strong stakeholder relationships while ensuring confidentiality and professional credibility. Ensure effective communication and collaboration between stakeholders. Operational and Management Responsibilities Effectively report on agreed strategies, plans, objectives, and outcomes. Manage Legal, Risk and Governance operational planning, budgeting, resourcing, policy development, and training requirements. Manage day-to-day operations within the Legal, Risk and Governance function. Lead and manage employees within the function, including performance management, development planning, and capability building. Act as the escalation point for issues involving third-party service providers and assist in resolving conflicts where required. Desired Experience & Qualification Grade 12. LLB Degree. Being an admitted attorney will be an added advantage. Membership of Compliance Institute of SA or similar body. A post graduate degree will be preferred. Minimum of 8 years of commercial experience, of which 5 must be managerial experience is essential. Medical Scheme Industry experience would be preferred. #J-18808-Ljbffr