Senior Legal Advisor

Senior Legal Advisor   

About Discovery

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About Clinical Benefit Advisory Team

The Clinical Benefit Advisory Team (CBAT), a subsidiary of Discovery Health, comprises Medical and Legal Advisors who offer clinical and legal expertise on complex cases. The Council Liaison Managers serve as the bridge between Discovery Health and the Council for Medical Schemes, providing support to the Legal Advisors. Additionally, the Medical Review Consultants ensure that clinical cases are thoroughly reviewed, and appropriate decisions are made. The team operates regionally in Sandton and Cape Town.

Key Purpose:

This position requires the successful candidate to manage legal disputes, regulatory complaints, and litigation, as well as providing legal assistance toDiscovery Health.

Key Outputs

The successful applicant will be responsible for but not limited to the following job functions:

• Oversee legal advisor in drawing up the Heads of Arguments (HOA) for all Disputes.

• Drawing up of all Section 48 hearings and Section 50 hearings at Council of Medical Schemes (CoMS)

• Argue cases at CoMS for Section 48 Hearings as an admitted attorney and whenever possible for Section 50 Hearings.

• Oversee the legal advisor in arguing cases before the Disputes Committee on behalf of DHMS at weekly Dispute Hearings.

• Provide general legal advice internally for matters related to the Scheme rules and interpretation of the PMB legislation for which this position bears the legal responsibility.

• Respond to legal letters of demand from members within strict deadlines as main legal respondent on behalf of DHMS and other Discovery Health administered schemes.

• Manage the mediation process before a matter goes on appeal.• Own legal relationship, in terms of Disputes and CoMS complaints, with the Discovery Health Senior Executive and Discovery Health Medical Scheme.

• Providing input and representation at relevant senior forums throughout the Discovery Health business.

• Own legal responses to CoMS and maintain positive relationship with all relevant stakeholders.

• Update the Benefit Compliance Review team and relevant business areas on CoMS and Dispute rulings as required.

• Provide monthly and quarterly trending and status reports.

• Track industry trends relating to the Appeal committee and to the Appeal Board decisions; assist with implementation of these decisions into Discovery Health.

• Accurate record keeping in line with company requirements and standards.

• Provide legal expertise for complex legal matters across multiple areas when necessary.

• Develop strategic and operational plans to minimize risk within the area.

• Assist in ensuring the company complies with legislation (Medical Schemes Act) to avoid statutory and/or regulatory consequences.

• Act as the liaison and provide the relevant level of instruction to the external legal panel comprising attorneys and advocates.

Competencies:

The successful candidate must demonstrate the following competencies:

Education and Experience:

The following requirements are essential:

• Matric
• LLB qualification
• Admitted Attorney or Advocate
• At least 1 year working experience in the medical scheme environment
• At least 5 years Litigation experience
• Knowledge of Managed Care Environment
• Sound knowledge of relevant Legislation
• Excellent written and verbal communication skills in English
• Basic computer literacy in Microsoft Office applications (must be proficient in Excel)
• Drafting of legal documents e.g. Heads of Argument, opinions, and legal letters
•  

The following requirements are advantageous:

• Knowledge of Discovery Health Medical Scheme and In-House products and protocols
• At least two years’ experience in large law firm
• Clinical /Medical knowledge

EMPLOYMENT EQUITY   
                             
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.