Chronic Benefit Consultant

1 week ago


Durban, South Africa La Lucia Hospital Full time

**Requirements**:

- Matric
- Post Basic Pharmacist assistant qualification is essential
- Previous Health Risk Management experience would be an advantage
- Previous experience in a managed care environment dealing with Health Risk Management would be an advantage
- Registration with the Pharmacy Council as Pharmacist Assistant would be an advantage
- Clinical Knowledge
- Computer literate
- Good telephone etiquette

Duties & Responsibilities
- All interactions, telephonic and written, with members, providers, brokers and internal stakeholders to be professional
- Registration of medicine and/or diagnosis to be done timeously and independently in accordance to La Lucia Hospital Health policies and scheme formularies
- Develop effective relationships and ensure that Service Level Agreements with External clients and internal departments are maintained thus ensuring excellent service to the scheme, members, providers as well as internally
- 24 hour turnaround -; Maintain a consistent and quality 24 hour turnaround time from receipt of documents/calls into the Medicine Risk Management department
- Provide 1st time and timeous resolution on queries
- Provide effective management of a patients disease and lifestyle to promote an integrated and holistic approach to managing the healthcare of a member
- To provide support and assistance to the DUR Pharmacist, DRM, HRM and Clinical Governance departments in terms of medical management and clinical input.
- Ensure effective claims management service delivery and support
- Perform an efficient and accurate administrative function to the team.
- Identify all compliance risks and bring to the attention of the team leader for review.
- Monitor customer delivery constraints and escalate to management
- Identify and investigate all possible non-disclosure of pre-existing conditions
- Identify the appropriate entry criteria and ensure consistent and correct authorizations in line with clinical policies and the relevant scheme rules and formularies
- Have the capacity to develop oneself and others via the various training options thus positively growing oneself and the team.

Competencies
- Customer focused
- Excellent verbal and written Communications Skills
- Good interpersonal skills
- Attention to detail
- Service oriental
- Stress tolerant and working under pressure
- Empathetic
- Proactive
- Highly motivated
- Drive and support effective teamwork within the Department

**Job Types**: Full-time, Permanent

**Salary**: R15,000.00 - R32,000.00 per month

**Education**:

- Certificate (preferred)

**Experience**:

- Consultant: 2 years (preferred)


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