Experience

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  Insight Actuaries & Consultants

  • Johannesburg Metropolitan Area

  • Medical Advisor

    • Jun 2024 - Present
    • Johannesburg Metropolitan Area

    Strategic Medical Advisor in the Healthcare Industry.Over the past 20 years Insight have built a comprehensive medical scheme and health insurance consulting capability which provides services to clients across multiple countries. We offer our clients insights and perceptions gained through a deep understanding of both funding (demand) and supply sides of the healthcare economy. We dig deeper into the data to understand the drivers of claims experience to suggest mitigations and improvements. Through the use of sophisticated projections models, advanced IBNR calculations, and standardised actuarial reporting we equip medical schemes and health insurers to better manage their product lines, and design improved products.Insight provides advice on managed care programs, provider network design and monitoring, and fraud analytics to help funders manage their risks. We help design and monitor alternative reimbursement models and progressive contracting between providers and funders including fixed fees, per diems, and capitation contracts. Insight’s Signal model analysis quantifies benefit richness for the market of schemes and options to show value for money to help identify competitive positioning and gaps in product range.

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  Bosele Foundation

  • Johannesburg Area, South Africa

  • Deputy Chairman

    • Feb 2014 - Present
    • Johannesburg Area, South Africa

    The Bosele Foundation is an education trust aimed at benefiting underprivileged children in resource-scarce communities by providing them with bursaries right fund their formal and extracurricular education. The Foundation also offers its beneficiaries exposure to professional and social opportunities otherwise denied to them because of their underprivileged backgrounds. Bosele is a Tswana word meaning “dawn”. It is the shared belief of the foundation that by providing underprivileged children with learning and personal development opportunities, and cultivating a more humanitarian culture, that we will finally see the dawn of the African Renaissance.

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  Polmed ZA

  • Pretoria, Gauteng, South Africa

  • Senior Manager: Clinical Services

    • Jan 2022 - May 2024
    • Pretoria, Gauteng, South Africa

    This role develops and implements compliant benefits to provide optimal healthcare services to members in a financially sustainable manner. It develops and implements effective, data analytics-driven, evidence-based healthcare delivery strategy to deliver optimal healthcare provision coverage and health outcomes. The role identifies opportunities for optimisation of healthcare costs, whilst ensuring delivery of quality healthcare services to members; and monitors implementation of healthcare provision including risk assessment, managed care and clinical support programmes, and provider networks. The role executes effective clinical governance and clinical audit practices within Polmed.

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  Medshield Medical Scheme

  • Johannesburg Area, South Africa

  • Medical Advisor: Clinical Risk

    • Oct 2018 - Dec 2021
    • Johannesburg Area, South Africa

    My advisory role at Medshield is to provide clinical validation and medical advisory function to requests made by healthcare providers on behalf of members for high cost procedures and medication as well as to identify and circumvent high cost drivers in the scheme’s healthcare expenses.

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  Discovery Limited

  • Sandton, Johannesburg

  • Medical Advisor: Clinical Advisory Services

    • Jan 2016 - Sep 2018
    • Sandton, Johannesburg

    I am an independent medical practitioner who worked at Discovery Health Pty (Ltd) in a medical advisory capacity. My advisory role at Discovery Health involved managed healthcare and making funding decisions for clinically complex cases while promoting cost effective and quality healthcare for members of Discovery Health Medical Scheme as well as the Inhouse Schemes that Discovery Health administrates. In addition I manage interactions with external clinical providers.

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  Dr Thobeka Cele (Private GP)

  • General Practitioner

    • Jan 2014 - Jul 2017

    Part-time Locum work at a private general practice.

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  Gauteng Department of Health

  • Doctor in Charge of Itireleng Community Health Centre

    • Mar 2015 - Dec 2015

  • Grade 1 Medical Officer

    • Jan 2014 - Dec 2015

  • Community Service Doctor

    • Jan 2013 - Dec 2013

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  East London Health Complex

  • Medical Intern

    • Jan 2011 - Dec 2012