Closing Date: 2025/02/07Reference Number: PPS250131-11Job Type: PermanentJob Title: Medical OfficerBusiness Unit: PPS InsCoDepartment: Life SolutionsLocation - Country: South AfricaLocation - Province: GautengLocation - Town / City: ParktownJob Advert SummaryTo provide specialist medical input, advice and expertise.
Understand how medicine and medical science impacts underwriting and claims and broader risk management within the long-term insurance business environment.
The key purpose of this role is to provide general medical input, advice and expertise regarding product development, risk underwriting and claim assessments.
To undertake research initiatives within the Research and Development area.
Participate in organisation strategic projects to support member acquisition, improve risk management and deliver a positive member experience.Minimum RequirementsMatricMBChbExperienceMinimum of 5 years' experience post full qualification as a Medical Doctor / Medical OfficerManagement experience would be an advantageExperience in occupational health, psychiatry or cardiology would be an advantageExperience in Long-term insurance would be an advantageKnowledge And Skills (maximum Of 10)Demonstrates awareness of market trends and opportunities and keeps up to date with competitor developments impacting area of responsibility.Is adept in the use of the latest MS Office package, particularly Excel, Word and Power-pointDemonstrates self-control, an ability to manage your time, be courteous, be patient, be able to gain control of situationsDemonstrates curiosity, think outside the box, promote solutions, innovateDemonstrates honesty and integrityDemonstrates strong business acumen, and solutioning within a pragmatic context.Is energetic, demonstrates drive, passion and is enthusiasticBe collaborative and provide support when working togetherAnalytical thinkingProblem solving and analysis.Professional and technical medical skillsDuties and ResponsibilitiesOngoing medical researchConduct research and collate data to influence and substantiate PPS'/glu's Underwriting and Claims assessment guidelinesConduct research and collate data to serve as input into product development initiatives related to area of specialisationAdvising on medical topics pertaining to the company's businessUnderwritingPlan for and process medical related tasks and activities effectively and efficiently in alignment with performance objectivesMedical assessment of complex new business cases in accordance with PPS/glu underwriting guidelines and risk appetiteParticipate in the design of new underwriting policies and review of existing underwriting policiesParticipate in underwriting quality control through validation of underwriting decisionsDraw on own technical or professional knowledge and experience to identify and develop solutions to improve ease of doing business and service qualityImplement and provide input into the development of governance and compliance processes within area of specializationProvide input into the design and development of underwriting automation solutionsClaimsPlan for and process medical related tasks and activities effectively and efficiently in alignment with performance objectivesMedical assessment and authorisation of complex or high value claimsParticipate in the design of new claims guidelines and review of existing claim guidelinesChair and monitor effectiveness of the Medical Officers Committee/Medical Claims Committee in accordance with Terms of ReferenceParticipate in claims quality control through validation of claim assessment decisionsAssist with disputed claims, Internal Arbitrator or Ombudsman complaintsDraw on own technical or professional knowledge and experience to identify and develop solutions to improve ease of doing business and service qualityImplement and provide input into the development of governance and compliance processes within area of specializationProvide input into the design and development of claim automation solutionsProduct developmentTo provide medical specialist input for new product development, product enhancements and special offersMedical research for product pricing purposesDrafting medical benefit definitions of new products and relevant sections of the policy wording and related documentsLiaison, Communication And Education FunctionsAdvising on local market developments, especially with regards to new products, and new underwriting or claims practicesRepresent PPS on ASISA committees if requestedPresentations to sales distribution and intermediaries if requestedPromote the organisation with other thought leaders and stakeholders, related to area of specialisation.Provide input into education and awareness communications related to medical topics and related product initiativesBuild relationships and interact positively with members, internal colleagues and intermediaries and act as an ambassador of the PPS/glu brandParticipate in industry events and contribute positively to own and organisational knowledge improvementProvide medical input into the design of claims and underwriting collateral including but not limited to forms, questionnaires, training etc.Maintaining a network with subject matter specialistsMember ExperienceContribute to a TCF and service excellence culture, which builds positive relationships and provides opportunity for exceptional service.Implement processes which support service delivery excellence according to TCF principles and encourage others to provide exceptional customer serviceStrategy and InnovationCo-lead and partner, with product development and other PPS/glu entities, in the development of innovative solutions aimed at improving ease of doing business with PPS/glu, throughout the policy lifecycle from onboarding through to claimsServe on key leadership forums, to support the development and execution on business strategic imperativesProvide input into strategic projects by understanding the business need and implications for area of specialisationProvide insights and opinions on strategic initiativesExecute on strategic deliverables
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