Hospital Benefit Specialist
3 weeks ago
Hospital Benefit Specialist – KZN Discover Limited is looking for a dedicated Hospital Benefit Specialist to join our field force in KwaZulu-Natal . Overview As a key member of the Discovery Care team, you will manage real‑time risk management for private hospital benefit requests and coordinate care to ensure members receive appropriate level of care. Key Purpose & Responsibilities Responsible for assessing case eligibility and funding decisions through a thorough process: Review member clinical history and benefit structure. Analyze clinical information and coding supplied. Determine level of care and appropriateness of facility, treating doctor and treatment. Approve or decline funding to protect scheme risk. Plan discharge alternatives (Hospital @ Home, Homecare, etc.). Effective and Accurate Communication Update providers on case status. Confirm funding decisions to members. Request additional information from treating doctors or practice managers. Engage Patient Services Manager and hospital staff. Handle escalations from providers and internal stakeholders. Present complex cases to clinical review teams. Analyze trends and propose efficiency improvements. Refer clinically complex cases for further management. Operational Targets Attend to patients on daily report. Review all low acuity admission requests. Maintain quality of processes. Competencies The successful candidate must demonstrate: Accountability, action orientation, and business insight. Effective communication, conflict management, and resilience. Customer focus, decision quality, and results delivery. Collaboration, innovation, and a global perspective. Technical savvy and trust building. Education and Experience Matric. Registered Nurse with valid SANC registration. 3 years clinical experience in a private hospital setting (ICU, trauma/casualty, medical/general ward). 2 years managed health care experience. Microsoft Excel experience. Valid driver’s license with own transport; travel up to 50 km may be required. Excellent verbal and written communication skills. Telephone etiquette and active listening skills. Advantageous Requirements 1–2 years ICU experience. Knowledge of DH SOPs and internal process experience. Provider payment arrangements (internal only). Clinical coding knowledge of ICD‑10 and/or CCSA. Personal Attributes Values‑driven, optimistic, and people‑savvy. Learns on the fly, resilient, and instills trust. Drives results and solves problems. Employment Equity As an Equal Opportunities employer, Discovery welcomes people with various disabilities to apply. The Company’s approved Employment Equity Plan and Targets will be considered during recruitment. #J-18808-Ljbffr
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Hospital Benefit Specialist
1 week ago
Durban, South Africa Medical Aid, Bank, Insurance, Invest & Vitality Full timeHospital Benefit Specialist - KZN About Discovery Discovery's core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose and whose own values align with those of Discovery. Our fast‑paced and dynamic environment enables smart self‑driven...
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Hospital Benefit Specialist
4 weeks ago
Durban, South Africa Discovery Full timeHospital Benefit Specialist - KZN About Discovery Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven...
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Hospital Benefit Specialist
2 weeks ago
Durban, South Africa Medical Aid, Bank, Insurance, Invest & Vitality Full timeHospital Benefit Specialist About Discovery Discoverys core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart self-driven people to be...
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Hospital Benefit Specialist
2 days ago
Durban, South Africa Discovery Ltd. Full time**Business Unit**:Discovery Health **Function**:Clinical **Date**:26 Feb 2025 **About Discovery** Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced...
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Durban, South Africa Discovery Full timeA leading healthcare company in Durban seeks a Hospital Benefit Specialist responsible for assessing clinical cases and managing benefits for members. The ideal candidate has a nursing background, strong communication skills, and a passion for healthcare excellence. Experience in a clinical setting is essential for success in this dynamic role, which offers...
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Hospital Benefits Specialist
1 week ago
Durban, South Africa Medical Aid, Bank, Insurance, Invest & Vitality Full timeA leading health services provider in KwaZulu-Natal is looking for a Hospital Benefit Specialist. The role involves assessing clinical cases, managing funding decisions, and effective communication with stakeholders. Candidates must be registered nurses with SANC registration and possess clinical experience. This full-time role is vital in ensuring members...
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