Technical SpecialistOperationsLiberty HealthPrimary FunctionTo ensure that all product rules/scheme rules, tariffs and relevant master files are loaded, tested, verified and maintained on the Liberty Health operating system to ensure that claims are processed (paid/rejected) correctly.Outputs1 To ensure product rules are set-up correctly, tested and put live once signed-off as well as training material updated. 2 To communicate with in-country managers regarding rule set-ups and ensure the correct application thereof through training interventions. 3 To ensure coordination with relevant stakeholders and assist with investigation on overall enhancements and requests that will impact the claims system in order to improve processes and assist with the mitigation of risk. 4 To ensure the completion of relevant ad hoc data extracts correctly and timeously in order to inform the impact analysis performed in other business areas. 5 To provide input, as requested, into the accuracy of documents such as training manuals, year-end impact analysis reports etc. 6 To ensure the quality assurance of sample claim statements on a weekly basis prior to release. 7 To perform ad-hoc impact analysis as and when required.Internal Customers/Stakeholders External Customers/StakeholdersBusiness Enablement Relevant 3rd party providersOperations In Country teamsMember Care Fund Management DecisionsDecisions regarding the correction of rules within the outlined and agreed upon scope of the role Knowledge Level (Basic, Intermediate, Advanced)Claims AdvancedRegulatory requirements IntermediateScheme Rules/Product Rules IntermediateMedical Aid Industry / Health Insurance IntermediateMembership/Contributions/Premiums BasicMedware IntermediateSkills Level (Basic, Intermediate, Advanced)Computer skills — MS Office (specifically Excel) IntermediateInterpersonal Skills BasicWritten and verbal communication IntermediateAttention to detail AdvancedMethodical thinking, accuracy AdvancedProblem solving IntermediateEducation Essential / AdvantageousMatric EssentialRelevant Certificate / Diploma AdvantageousType of Experience Industry Years Essential / AdvantageousTechnical Specialist Health / Insurance 3 — 4 EssentialMedical Aid/Health Insurance Health / Insurance 3 – 5 EssentialClaims Health / Insurance 1 – 2 EssentialPremium / Membership Health / Insurance 1 – 2 AdvantageousBehavioural AttributesAdhering to Principles and ValuesAnalysingApplying Expertise and TechnologyDelivering Results and Meeting Customer ExpectationsFollowing Instructions and ProceduresPlanning & OrganisingPresenting and Communicating InformationWorking with People
