Pre-authorisation Consultant

2 weeks ago


Pretoria, Gauteng, South Africa HRInsync Full time

Company
One of the largest private Medical Aid companies in SA. They have been established for 20 years and are striving to be #1 in SA.

Purpose
Delivering cost-effective managed healthcare services to accomplish member satisfaction.

Responsibilities:

  • Client Relations, To assist the client by approving appropriate funding
  • To deliver an effective call centre service in order to achieve member satisfaction
  • Risk Management, To reduce the risk associated with hospital and authorized cases
  • Telephone Etiquette, Answering telephone calls in a way that achieves member satisfaction
  • Risk Management, To reduce the risk associated with hospital and authorized cases
  • Verifying prosthesis limits, To contain costs for both members and fund
  • Ongoing training and development, To update knowledge and skills in order to deliver a costeffective and professional service
  • The actual benefit expenditure per beneficiary per month for hospitalization should be less than the budget benefit expenditure
  • Preauthorization should be granted within the option benefits, Scheme and clinical protocols
  • Effective Customer Service delivery
  • To deliver an effective call centre service in order to achieve member satisfaction
  • Delivering a costeffective Managed Healthcare service

Requirements:

  • Minimum 1 year Medical Aid Industry experience
  • Minimum 5 years Nursing Practitioner experience
  • Enrolled Nurse Qualification required

Job Types:
Full-time, Permanent

Application Question(s):

  • Enrolled Nurse Qualification essential

Education:

  • Diploma (required)

Experience:

- nursing practitioner: 5 years (required)
- medical aid industry: 1 year (required)

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