Through our client-facing brands Metropolitan and Momentum, 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. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses. Role Purpose To design, execute, and optimise automated procedures, generating accurate reports on quality statistics, while providing technical expertise, support, and guidance to enhance processes and drive business efficiency through technology. Qualifications Grade 12 Relevant tertiary qualification (Advantageous) Claims School training (Advantageous) Experience Minimum 1‑3 years’ Medical Aid Claims Assessing experience (Essential) Exceptional understanding of the Healthcare Industry with specific focus on Scheme rules as per the operational area (e.g., claims /membership / premiums etc.) (Essential) Thorough understanding/proficiency of the operational system/s (i.e., Reflections, cubes, web / internet search, interfacing processes, O2 (HiP), Oracle (Advantageous) Advanced computer literacy in MS Office (Advantageous) Transfer of knowledge to team and other business areas internally and externally Be able to interact at all levels with internal and external stakeholders. Be willing to work after hours when required Duties & Responsibilities Operational Business Processes Provide high quality business operation and technical support to ensure that the organisational processes are maintained Apply innovative/creative thinking by identifying gaps, proposing, and presenting solutions/enhancements with the view of maximising efficiency, minimising administrative cost and mitigate audit findings aligned with the day‑to‑day operations Liaise and build key relationships with internal and external stakeholders such as IT, SPN’s, Vendors, internal and external auditors, management etc Investigate and resolve any queries and business escalations received and ensure accurate and timely resolution Participate in external and internal audits on updates of medical scheme Tariff files and process auditing Drafting of SOP and review of existing SOP’s Drafting of Technical and interface specification and review of existing SPN processes for accuracy and validity Recommend and participate in the scheme’s rules design protocols Accurate Master file management and maintenance in line with audit protocols Update reference pricing, exclusion list and formularies Projects Analyse, actively participate and drive all internal and external stakeholders’ projects by liaising with the project manager and business analyst in order to execute project expectations which include both system and business processes Ensure that all projects are completed professionally, timely and in line with auditable requirements Co‑ordinate and manage the link between the external and internal business partners and IT and where necessary interpret and ensure the implementation of any changes Testing, Implementation and New Developments Analyse technical specification for internal and external business requirements including drafting of request for change (RFC) Perform User Acceptance Testing (UAT) testing for new developments rolled out to external and internal business interests Set up test packs / develop a testing plan according to technical specification and new development Trouble‑shoot and investigate system errors/bugs and log defects to Systems/IT if required Document new systems functionality for external and internal business interests in preparation for User Acceptance Testing (UAT) Reporting Implementation of reporting for internal and external stakeholders Testing and Quality Assurance of new reporting implementations Dealing effectively with inbound report requests emanating from areas such as the Scheme, SPN’s, and any other operational areas within MHS Provide SLA and other standard reporting to the scheme, auditors, SPN, etc Conducting adhoc investigations, taking cognisance of delivery deadlines and reporting requirements Providing assurance reports to perform key control reviews Perform key account reconciliations and reviews Improve and automate reporting functionality to limit the need for annual intervention Training Co‑ordinate with L&D to ensure end users are adequately trained by operational coach before new implementation and projects rolled out in order to create a pool of excellence Act as support for end users Interface, Monitoring and Controls Monitor, maintain and test new development of internal and external stakeholders Interfaces Proactively monitor and ensure functional and accuracy of interfaces Investigate and problem‑solve interface exceptions Liaise with internal and external stakeholders on any technical interface queries Ensure that incidents are managed and rectified timely at all times and escape any interface issues Implementation and management of controls in line with audit protocols Skills and Competencies Business Acumen Client / Stakeholder Commitment Drive for Results Leads Change and Innovation Impact and Influence Works independently. Diversity and Inclusiveness Ability to problem solve Proven Client relationship Management Time management Excellent written and verbal communication skills Ability to work in a pressurized environment. #J-18808-Ljbffr