Prospective Reviewer

2 weeks ago


Cape Town, South Africa Palesa Mbali Group Full time

Prospective Reviewer (Pre-Authorization Call Centre)

 

The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met.

 

Key Activities:

  • Authorizing hospital authorization requests by applying coding principles, medical scheme rules and benefits, and managed care policies and processes.
  • Capture accurate pre-authorisation data on the system
  • Educate and assist member by providing relevant clinical information to access the correct clinical benefits
  • Consult member's health care professional to make informed clinical decisions and manage financial risk
  • Correctly escalate complex clinical call
  • Provide excellent customer service
  • Address all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in

Education and Experience:

  • Formal nursing qualification (SANC enrolled nurse) – required
  • 2 – 3 years’ experience in a general medical or general surgical ward, with at least 1 year at a private institution
  • Minimum of 3 years in the clinical space required
  • Must be computer literate
  • Call centre experience advantageous
  • Previous Managed Healthcare experience in a call centre environment – advantageous

Company Description:

A highly respected company with many of the top medical schemes under their umbrella

 


  • Prospective Reviewer

    2 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    **Prospective Reviewer (Pre-Authorization Call Centre)** The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. **Key Activities**: - Capture accurate...

  • Prospective Reviewer

    2 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    Prospective Reviewer (Pre-Authorization Call Centre) The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. Key Activities:Authorizing hospital authorization requests...

  • Prospective Reviewer

    2 weeks ago


    Cape Town, South Africa Adzuna ZA B C2 Full time

    Prospective Reviewer (Pre-Authorization Call Centre) The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. Key Activities:Authorizing hospital authorization requests...

  • Prospective Reviewer

    2 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    Prospective Reviewer (Pre-Authorization Call Centre) The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. Key Activities:Authorizing hospital authorization requests...

  • Prospective Reviewer

    3 months ago


    Cape Town, South Africa WNS Global Services Full time

    Company Description **WNS (Holdings) Limited (NYSE: WNS)** is a global Business Process Management (BPM) leader. WNS offers business value to 400+ global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance,...


  • Cape Town, South Africa Vantage Debt Management Full time

    Vantage is looking for ambitious, energetic, and intelligent individuals to join its growing team. Be a part of a young and exciting start-up in the financial services industry. If you are interested in making a positive impact on people’s lives and growing your finance career at the same time, this is the opportunity for you. **Responsibilities...


  • Cape Town, South Africa Vantage Debt Management Full time

    Vantage is looking for ambitious, energetic, and intelligent individuals to join its growing team. Be a part of a young and exciting start-up in the financial services industry. If you are interested in making a positive impact on people’s lives and growing your finance career at the same time, this is the opportunity for you. **Responsibilities...


  • Cape Town, South Africa Voyc Full time

    Voyc is an award-winning conversation intelligence and compliance monitoring software specifically developed for financial services firms’ contact centes. Voyc helps financial services companies be compliant and improve customer service by monitoring 100% of their customer interactions. Voyc uses AI to transcribe, automatically analyse and review customer...

  • Lead Generator

    3 months ago


    Cape Town, South Africa National Debt Advisors Full time

    **National Debt Advisor is looking for a Lead Generator to join their team!!!** **Job title: Lead Generator** **Department: Sales** **Position type: Full time** As a **Lead Generator**, your role is to dial and find potential qualifying clients for debt review, prospecting process, needs analysis, and client report building, and find the ideal potential...


  • Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    Job Title: Prospective ReviewerAt Palesa Mbali Group, we are seeking a highly skilled and experienced Prospective Reviewer to join our Pre-Authorization Call Centre team.Key Responsibilities:Authorize hospital authorization requests by applying coding principles, medical scheme rules, and benefits, as well as managed care policies and processes.Capture...


  • Cape Town, South Africa Boldr Full time

    A LITTLE BIT ABOUT Boldr - Boldr is the first global B-Corp dedicated to delivering world-class Client experiences while creating access to dignified, meaningful work in communities worldwide. - We are a global team, united by our desire to connect diverse people with common values for boldr impact. - We employ just over a thousand team members across five...


  • Cape Town, South Africa Curiska (Pty) Ltd Full time

    New & Existing Clients: - Scan client base and target market for financial planning opportunities - Generate leads by identifying appropriate clients/prospects - Contact clients/prospects to introduce or position products and service offering - Create interest and secure financial planning meetings with prospects/clients - Deliver quality financial planning...


  • Cape Town, South Africa Amazon Commercial Services (South Africa) (Pty) Ltd - N09 Full time

    6+ years of professional non-internship marketing experience - Experience using data and metrics to drive improvements - Experience building, executing and scaling cross-functional marketing programs - Experience communicating results to senior leadership - Experience using Microsoft Excel to manipulate and analyze data - Bachelors degree in marketing or a...


  • Cape Town, South Africa Boldr Full time

    A LITTLE BIT ABOUT Boldr Boldr is the first global B-Corp dedicated to delivering world-class Client experiences while creating access to dignified, meaningful work in communities worldwide. We are a global team, united by our desire to connect diverse people with common values for boldr impact.  We employ just over a thousand team members across five...

  • Senior Accountant

    1 week ago


    Cape Town, Western Cape, South Africa Sagen Advisory Full time

    Accountant Job OpportunitySagen Advisory, a reputable audit and accounting firm, is seeking a skilled Accountant to join their team in Malmesbury. This is an excellent opportunity for an ambitious professional to grow with a practice that offers excellent career prospects and a collaborative work environment.Key Responsibilities:Perform high-level accounting...

  • Sales Executive

    4 months ago


    Cape Town, South Africa Credit Correction Full time

    **Objectives of this role** - Generate leads and build relationships by organizing daily work schedule to call on existing and potential consumers - Achieve weekly, monthly, and annual sales targets **Responsibilities** - Identify prospects and make effective qualifying sales calls, and manage sales cycle to close new business in all service categories -...

  • Telemarketer

    2 months ago


    Cape Town, South Africa West Coast Personnel Full time

    The telemarketer will be responsible for cold calling and promoting, company products and solutions. Requirements:Minimum requirement Matric.Experience in similar telephony driven sales and customer service role.Positive attitude and strong desire to provide outstanding customer service.Fluent in English and AfrikaansGood written communication skills Duties...

  • Investment Planner

    3 months ago


    Cape Town, South Africa Arivu Recruitment and Consulting Full time

    Location: Newlands, Cape Town, Western Cape Remuneration: R25 000.00 basic + commission A financial services client is looking for a financial planning professional to join their growing team of Investment Planners. The role is ideal for a financial professional with 3-5 years’ working experience in the area of financial planning and investment advice....


  • Cape Town, Western Cape, South Africa Recruitment Full time

    Job DescriptionJob Title: Outbound Insurance AgentJob Type: PermanentLocation: Cape Town, Western CapeAbout the Company: Our client is a leading provider of innovative and affordable family insurance solutions.About the Role:We are seeking a highly motivated and results-driven Insurance Sales Representative to join our team. As an Insurance Sales...


  • Cape Town, Western Cape, South Africa Recruitment Full time

    Job DescriptionJob Title: Outbound Insurance AgentJob Type: PermanentLocation: Cape Town, Western CapeAbout the Company: Our client is a leading provider of innovative and affordable family insurance solutions.About the Role:We are seeking a highly motivated and results-driven Insurance Sales Representative to join our team. As an Insurance Sales...