Hospital Benefits Management Specialist

2 weeks ago


Pretoria, South Africa Tych Business Solutions Full time

**Job ID**: 58560**Date Posted**: Posted 6 hours ago**Location**: Pretoria, Gauteng**Job Title**: HOSPITAL BENEFITS MANAGEMENT SPECIALIST - PERSONS WITH DISABILITIES - PRETORIA

**Duties**:

- The Specialist is required to provide support to Manager for effective oversight of all managed care processes including:
All hospital pre-auth processes
All case management processes
Access to and utilisation of In lieu of hospitalisation benefits
Oversight of all relevant inter SPN integration processes
Other projects as defined and aligned to Scheme Strategy
- Attend various Forums and contribute to effective strategic clinical and utilisation risk management.
- Support the accurate and timeous roll out of all defined programmes.
- Assist in the development and implementation of a quality assurance and utilisation review programme for hospital benefits.
- Support the development, evaluation and revision of SOPs in relation to hospital benefits and clinical risk management.

Requirements:

- 3-year Degree, Diploma or NQF Level 6 Diploma/Degree in Medical/Clinical Sciences Qualification (Nursing qualification advantageous)
- 4-6 years work experience in the healthcare funding/medical schemes industry
- Solid Hospital Benefits and Disease Risk Management Operations experience with Medical Scheme operational insight
- Be analytical and can manage priorities
- Have excellent written and verbal communication and interpersonal skills
- Critical thinking skills
- Ability to work independently under pressure and as part of a team
- Team player with good organisational skills
- Adaptable and resilient
- Project Management skills will be an added advantage
- Proficient with MS Office Suite
- Must be in possession of a valid driver’s license and be willing to travel at short notice



  • Pretoria, South Africa Specialist Confectionery Full time

    A successful specialist confectionery business with 15 branches all around Gauteng requires a Production Manager to manage the people, products, processes and output of the entire confectionery production The company's main production operations are in the Pretoria, which is where the production manager will be based Must have at least 5 year experience in...

  • Cardiologist

    1 month ago


    Pretoria, South Africa Mediclinic Heart Hospital Full time

    Cardiologist Gauteng  THE RIGHT ADDRESS FOR YOUR EXPERTISE Mediclinic Southern Africa is always looking to offer exciting private practice opportunities to specialists and doctors at our facilities across South Africa and Namibia. Mediclinic Heart Hospital takes pride in the fact that we were the first, and still are, the only hospital of its...


  • Pretoria, South Africa Specialist Confectionery Full time

    A successful specialist confectionery business with more than 16 branches all around Gauteng requires a Production Manager to manage the people, products, processes and output of the entire confectionery production The company's main production operations are in the Pretoria, which is where the production manager will be based Must have at least 5 year...

  • Hospital Manager

    4 weeks ago


    Pretoria, South Africa Professional Sourcing Full time

    **Job Overview**: **Hospital Manager** **Location: Pretoria, Gauteng** **Position Overview**: A remarkable **medical institution in Pretoria** is seeking to appoint a **Hospital Manager.** One’s responsibility will be to** execute strategic and operational objectives in growth, continuous improvement, clinical excellence, and leadership** to **meet the...


  • Pretoria, South Africa Medpharm Recruitment Full time

    A reputable Medical Aid is seeking an experienced Medical Aid Claims Assessor to join their HBM team in Pretoria. (Office based) **Requirements**: - Grade 12 - Staff/Enrolled or Registered Nurse (SANC) - Minimum 5 years’ experience as a Nursing Practitioner - Minimum 1 year experience gained in the medical funding industry - 1 year Medical Aid claims...


  • Pretoria, South Africa University of Pretoria Full time

    RESPONSIBILITIES: Reporting to the Director-Human Resources the successful incumbent will be a member of the Human Resources Management team. The incumbent will also be responsible for providing strategic and operational leadership and management of Remuneration, Benefits and Organisational Design Division (RBOD) and support the Director-Human Resources in...


  • Pretoria, South Africa Adzuna ZA B C2 Full time

    Job Specification: Clinical Research and Development SpecialistLocation: GautengAbout Our Client: Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients.The position: Our client is seeking a...


  • Pretoria, South Africa Companies & Intellectual Property Commission Full time

    **INTERNAL ADVERTISEMENT** *** **Remuneration and Benefits Manager** **Job Grade: P7** **Ref No.**:R050001** **Job Purpose**: To effectively advise on and manage the remuneration and benefits framework and human resource records within the CIPC **Key performance areas**: - To implement and maintain the CIPC’s remuneration strategy; - To monitor the...


  • Pretoria, South Africa HotelJobs.co.za Full time

    **Employer Description** A reputable Group of Resorts located throughout South Africa. Head Office is in Pretoria. Our Client, a reputable Group of Resorts located throughout South Africa, with head office in Pretoria, seeks an experienced Hospitality Corporate Sales Executive. Standard Corporate Market sales executive duties will apply. Proven track...

  • Product Specialist

    1 month ago


    Pretoria, South Africa Glasshouse Recruiting Full time

    Full Time _Gauteng_, _Pretoria_ January 24, 2024 - February 24, 2024 Medical Sale **Job Overview**: **Requirements**: - Strong Medical Background within Hospital environment - Relevant academic qualifications a distinct advantage - At least 2 years medical experience with related in Theatre and in-service experience - Experience in new business...


  • Pretoria, South Africa Status Asset Management Full time

    Position: Collections SpecialistLocation: Pretoria  Are you all about ensuring money owed to the Company is obtained? Are you well versed with negotiations and have an unrivalled ability to persuade clients, to reach a certain outcome? Do you achieve client satisfaction? Then you raise your hand because WE'RE HIRING!!!  This role plays an integral part in...

  • Unit Manager

    1 month ago


    Pretoria, South Africa Mass Staffing Projects Full time

    **Job Information** - Location- Nursing Jobs in Pretoria- Salary- 430K - 300K- Job Type- Permanent- Education- Clinical Facilitation Certification- Experience- 3 + years of experience- Reference- MH26102021MW- - pharmacy.jobs(at)staffingprojects.co.za- Fax- 0866023398In Pretoria, a hospital is currently looking to fill the role of Unit Manager in the private...


  • Pretoria, South Africa Status Asset Management Full time

    Position: Corporate Legal SpecialistLocation: Lynwood, PretoriaReporting To: Group Chief Operations OfficerAbout Us:Numeral is a young, energetic, and passionate group of companies working in different industries, all focused on becoming market leader in our fields. Our fast-paced environment will positively challenge you and keep you engaged as you navigate...


  • Pretoria, South Africa Mastech General Trading Full time

    One contract position for Medical Benefits Administrator is available.The position will be filled as a 12-months contract position. The incumbent will be responsible for a wide variety of tasks which includes but are not limited to the following: 1.Ensure documents received are read-in and read-out. 2.Ensure that all documents are correctly pre-verified...

  • Case Manager

    1 month ago


    Pretoria, South Africa care force Full time

    Our client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. Position: Case Manager (Member Management) Reporting to: Senior Specialist Clinical Management Location: On-site...


  • Pretoria, South Africa MCR – Medical and Management Corporate Recruiting Full time

    Responsible for leading the technical team in effectively and efficiently achieving the objectives of the department. Managing costs, the budget, and resources in line with but not limited to the following technical, clinical, and operational requirements. **Requirements**: - Relevant Engineering qualification (Mechanical Engineering or similar-NQF 7),...


  • Pretoria, South Africa Status Asset Management Full time

    Position: Investment Sales Specialist Location: Pretoria  Are you all about client services and addressing customer concerns? Are you a fantastic salesperson with the ability to meet deadlines? Do you love working with people and ensuring they feel heard? Then raise your hand because we’re HIRING! This role plays an integral part in our team, as you are...


  • Pretoria, South Africa MPASSI Holdings (Pty) Ltd Full time

    Handle guest bookings - Interacting with customers and check-in - Maintain a positive relationship with guests - Provide basic Housekeeping duties including rearranging the room after guests check out, changing the sheets, changing and arranging the towels, restocking room supplies, perform detailed deep cleans, assist with laundry including washing, drying,...

  • Portfolio Manager

    4 weeks ago


    Pretoria, South Africa Pillango Placements Full time

    **Gauteng**, PTA - East** **R 40000 - R 50000 Monthly Cost To Company (Negotiable)** This role offers an incredible opportunity to develop professionally while managing a significant portfolio of diverse clients, including top corporate and individual accounts. If you thrive in a dynamic environment where problem-solving and client service excellence are...

  • Finance Executive

    1 month ago


    Pretoria, South Africa Measured Ability Group Holdings Full time

    **South Africa - Gauteng**, Tshwane (Pretoria / Shoshanguve / Bronkhorstspruit)** **(Negotiable)** **Our client in the Medical sector, requires a Finance Executive with a BComm and Articles to oversee Financial Control and management of the full function. Salary highly negotiable.** ***: - **Qualification in Financial Management and Auditing - BCom...