Legal Services Specialist

Medshield Medical Scheme

Gauteng, South Africa


Oct 8

To provide strategic legal services and expert legal advisory services to the Scheme; identifying legal opportunities and risks relating to legislative compliance, potential implications on various corporate strategies, and business initiatives and projects as well as contracts management across the Scheme. -Provide input into the development of the sub-divisions strategy. -Develop a supporting tactical plan for the Legal sub-division to ensure execution of the strategic objectives and goals.-Drive the implementation of the tactical plan by developing and allocating operational activities, and ensuring alignment to the achievement of operational targets.-Ensure the establishment, maintenance and improvement of Standard Operating Procedures, policies, and guidelines relating to the Legal sub-division in consultation with the Executive: Corporate Services.-Provide advocacy on a legality assurance perspective to the Schemes strategic decision-making process. -Use insights gained through business information to compile reports, and metrics to measure success and inform the business decision making process and realign objectives.-Monitor and continuously evaluate progress of the sub-divisions achievements against the tactical plan and strategic objectives.-Lead the implementation of changes to business processes and/or operations in order to comply with amendments to the legislation aligned to strategic objectives.-Prepare a dossier on both Court and Arbitration proceedings in defence of the Schemes case and hand it to the external law firms litigating on behalf of the Scheme.-Oversee all Scheme ongoing litigations and attend Court and Arbitration hearings as required.-Advice the Scheme regarding amendments to the Scheme rules.-Report and present to the Board of Trustees on all litigious matters and allow the Board to make informed strategic decision on the matters.-Compile a dossier for submission for claims to the insurer and ensure that claim payment conditions and protocols are adhered to. -Advice the Scheme regarding the interpretation and the application of Scheme rules and the Medical Schemes Act, Road Accident Fund (RAF) Act and claims management for RAF related matters.-Provide advocacy to Human Capital on labour related matters as required. -Investigate employee contraventions of the policies with an intention to institute disciplinary actions.-Draft, review and interpret contracts for the Scheme and Board of Trustees and update them on the Schemes contractual agreements.-Provide legal advice on and provide input into contracts the Scheme enters into with external parties.-Create and maintain a contracts register of all original contracts.-Ensure the research and drafting of legal opinions as required by the Scheme to inform the Schemes decision making process, including for 3rd party injury claims.-Draft letters in response to complaints and/or letters of demand from attorneys representing members.-Consult with law firms to conduct legal business on behalf of the Scheme, in accordance with the PO and Board of Trustees directives.-Manage the Schemes Legal related service providers.-Assist with any CMS matters that required an input from the legal department, including annual Scheme rules approvals.-Provide feedback and updates to the relevant departmental Executive on their claims payment process-Provide input into the departments risk register in consultation with the Manager: ARC.-Ensure the mitigation of the departments risk profile through the application of fraud controls and risk prevention principles and implementing of sound governance and compliance processes and tools to identify and manage risks.-Responsible for the coordination and maintenance of quality risk management in line with the requirements from ISO9001:2015.-Monitor changes in the regulatory environment and ensure that appropriate operational controls are implemented to address new requirements.-Support and provide evidence to all internal, external and ISO audit requirements.-Oversee the maintenance and enforcement of all technical related Service Level Agreements to minimise business risk and ensure business continuity. -Ensure adherence in the Clinical Risk team to all relevant laws, policies and Standard Operating Procedures throughout the organisation.-Provide input in the planning and compilation of the departments annual budget aligned to the tactical delivery plans to support the implementation of set objectives. -Ensure the effective implementation, management, monitoring of the departments budget, and mitigate and report on any variances.-Ensure the deployment of proper financial controls to manage the departmental budget. -Report on and communicate any costs improvements and shortfalls.-Build and lead an effective and cohesive team through the effective management of departmental resources.-Drive the implementation of talent acquisition, succession planning, development, and retention strategies for the department. -Ensure the enhancement of relevant knowledge and skills through continuous coaching, mentoring and nurturing of departmental talent. -Create a high performance culture and manage team performance effectively by translating and communicating the annual performance goals and measures into individual work plans based on agreed upon objectives.-Ensure that the working environment contributes to improving employee engagement, recognition and increased productivity.-Ensure that management of poor performance and disciplinary matters in line with the Schemes policies and procedures.-Build and maintain internal and external stakeholder relationships for the purposes of expectations management, knowledge sharing and integration of legal services.-Building understanding of legal issues, risks and obligations through advice, communications and training, especially for other legal services and managers.-Participate in the internal CMS Committee that reviews and deliberates on member complaints lodges with the CMS.-Prepare for and represent the Scheme in engagements with Unions, CCMA Hearings and CMS Appeals Committee.

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