Case Manager - South Africa

The Member Cases and Claims Division is at the forefront of protecting the careers, reputation and financial risk of our members worldwide. The purpose of the role is to support the provision of excellent case handling services for members which is trusted and valued and provides fair treatment and outcomes. The role will do this by managing a case load of files and using expert knowledge and judgement to formulate strategies in order to advise and guide members on relevant processes, ensuring an excellent member service is provided.

Role Responsibility

Responsibilities will include but not limited to the following:

Service Delivery

1. Deliver the performance of assigned case files in accordance with governance, policy and process ensuring quality and fair outcomes for the member and the membership fund.
2. Proactively manage assigned case files and work effectively to deliver within agreed SLAs ensuring maximum efficiency is achieved whilst providing an excellent service to the member.
3. Escalate as required any technical matters and/or for advice using such opportunities to build confidence and competence in role.
4. Support Case Handling projects/initiatives ensuring delivery of projects to time, cost and quality and that can demonstrate a return on investment.
5. Manage all spend incurred serving members in accordance with MPS organisation governance and policy.
6. Minimise case costs through proactively managing estimates, challenging costs and invoices from all third party.
7. Determine the level of member assistance to be granted in accordance with the membership policy and benefits on individual cases; escalate cases where out of policy discretion requires consideration.

Member

1. Manage informal complaints / expressions of dissatisfaction to achieve first touch resolution for our members and in accordance with policy standards and process ensuring fair outcomes for members, the membership fund.
2. Seek opportunities to continuously improve ways of working and contribute to team, department and divisional continuous improvement projects aimed to drive operational efficiency and great member experiences and outcomes.
3. Deliver at all times fair treatment and outcomes for members and compliance with associated policies and standards set out by Council, its committees and delegated authorities.
4. Using the most appropriate channel of communications, keep members regularly informed ensuring the advice and support reflects policy, relevant codes of practice, is technically accurate and with outcomes delivered in a professional and empathetic manner.

The Ideal Candidate

• Educated to degree level or equivalent experience in similar field / role.
• Knowledge of medical/dental law and ethics, and regulatory environment, policies and procedures.
• Legal or medical /dental qualification.
• Management of claims / cases of varying complexity.
• Experience in healthcare or legal background.
• Experience of training, coaching or mentoring.
• Regulatory / Inquests / Criminal Case management.
• Working with medics / dentists or other professional bodies.

Package Description

Benefits will include:

• Bonus (up to 15%).
• Pension.
• Medical Aid.
• Group Life Cover.

About the Company

Details about the company will be provided during the interview process.