RESPONSIBILITIES TOWARDS MANAGEMENT
Empower management to implement and manage a holistic healthcare policy that will enhance the overall wellness of its employees.
Ensure that management is empowered to provide employees with the most suitable medical scheme solutions in terms of costs, benefits, financial stability, administration & client services.
Regular independent market comparisons of various medical schemes to ensure that employees belong to the most suitable medical scheme(s)
Ensure that management is informed of any legislative matters relating to the medical schemes industry. Advising management to be pro-active in terms of any internal policy changes when required.
Generate management reports at least once every quarter to monitor membership movements and to pro-actively identify any trends that need to be addressed.
To minimise the burden put on management to resolve medical scheme related problems.
MEMBERS
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Ensuring courtesy calls are made to the Human Resources/Payroll Department and visits being arranged on a regular basis to ensure the efficient administration of the day-to-day medical scheme arrangements.
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Providing assistance to the Human Resources/Payroll department with monthly membership movements and reconciliations.
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Providing assistance with year-end revisions to help members choose the most appropriate options according to their unique needs.
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Conducting group education sessions on a regular basis.
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Attending to individual member claims queries/problems, where members can contact Maxima Advisors (Pty) Ltd directly for assistance. The turnaround times of queries range from between 24 hours to 10 working days, depending on the complexity of the query.
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Examples of queries are:
A member’s claim was not paid, or member has a benefit enquiry – turnaround time is 24 hours
Chronic medication approval enquiry – turnaround time is 2 to 3 working days.
Hospital account incorrectly paid – turnaround time 5 to 10 working days.
Members will be kept up to date throughout the duration of the query via telephone, fax or e-mail and all records are kept at our offices. Once the query is concluded, records are forwarded to the member.
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Assisting new members with their plan selection and the calculation of their contributions.
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Providing assistance with chronic medication applications.
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Providing assistance with ex-gratia requests.
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Obtain membership and tax certificates on behalf of members.
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Ensure that all the necessary stock, correspondence etc. are provided to the Human Resources department.
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Determining the need for member communication and arranging for the following:
“Easy-to-understand” written communication, which is distributed to all members via the Human Resources department.
Individual communication conducted via telephone, fax and e-mail.
Conducting member education sessions on a regular basis in every region. The most important sessions are at the end of the year when members need to be informed about their new contributions and benefits. Members are guided to select the most appropriate benefit options for their particular needs.
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Holding regular helpdesks at the premises of the client.