Compliance Specialist (Medical Insurance)

SUMMARY:
Compliance Specialist with experience in the medical aid / medical insurance sector needed.

POSITION INFO:

Key Responsibility:

• Accurate and timeous capturing of complaints and claims reviews, including updating the various registers.

• Chair the Ex-gratia, Complaints Management and Claims Escalation Committees.

• Manage daily workflow complaints received from various sources, reviews on Google, Hello Peter and social media platforms.

• Effective timeous and professional communication with both internal and external stakeholders. Respond to complaints and queries as per set standards where possible within 24 hours.

• Take full responsibility in developing and/or reviews of company policies, policy renewals, policy wording, and processes, including system and data requirements, that affect the Compliance function.

• Maintains awareness of regulatory framework and specific obligations within Financial Advisory, Intermediary Services (FAIS) Act, Council of Medical Scheme (CMS) rules and policies, code of conduct and requirements.

• Keep up to date with all legislative requirements impacting Unity Health and either implement or provide guidance on policies and procedures that need to be reviewed or implemented.

• Provide training, if necessary, on topics relevant to the Compliance function.

• Regularly assist to update the process manuals, standard operating procedures, and business rules for each process within the Compliance function.

• Compliance audits/reviews once every 3 months for internal departments.

Qualifications: -

• Bachelor’s degree in law or equivalent

• FAIS Compliant (RE5 & Qualification are a pre-requisite)

Skills and Experience:

• At least four years’ work experience in a compliance position within a medical insurance/medical aid environment.

• Expert knowledge of legislation applicable to the medical insurance/medical aid industries.

• Pays attention to detail and strives to be accurate at all times.

• Ability to work with minimal supervision.

• Ability to handle multiple simultaneous tasks and to function well under pressure.

• Interested in learning and progression.

• Ability to take initiative with strong administration skills.

• Excellent written and verbal communication skills.

• Strong problem-solving, assessment, and interpretation skills.

• Exceptional interpersonal skills.

• Deadline driven and ability to work in a high-pressure environment.

• Proficient with the entire Microsoft Office suite, i.e., Word, PowerPoint Tand Excel.

 • Assist EXCO members to compile Quarterly Service Level Reviews, complaints management reviews for the insurers.

• Implements the organisation''s or business units'' compliance program.

• Consults on an on-going basis with operational managers.

• Ensures conformance with applicable laws and regulations covering diverse fields.

• Monitors Financial Advisory, Intermediary Services and Council of Medical Scheme (CMS) compliance to ensure that the company complies with all financial soundness, licence conditions, annual levies, statutory requirements etc.

• Maybe responsible for the control of the Know Your Customer (KYC)

• Assist with any external audit requirements.

• Assist with various general duties in the department as assigned by the Manager.

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