Chronic Benefit Consultant

7 days ago


Durban, South Africa Momentum Metropolitan Holdings Full time

-Introduction

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
Role Purpose
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 is essential
- 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 MMI 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 oriented
- Stress tolerant and working under pressure
- Empathetic
- Proactive
- Highly motivated
- Drive and support effective teamwork within the Department
Enquiries
-

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.



  • Durban, South Africa Health Solutions Full time

    **Introduction** Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by...


  • Durban, South Africa Momentum Metropolitan Holdings Full time

    -Introduction Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using...


  • 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...


  • Durban, KwaZulu-Natal, South Africa Discovery Limited Full time

    Select how often (in days) to receive an alert:Business Unit: Discovery HealthFunction: ClinicalDate: 26 Feb 2025About DiscoveryDiscovery'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...


  • Durban, South Africa StaffCentral Consulting Full time

    **Job Duties/Responsibilities will include**: Designing a remuneration strategy, policy and solutions in collaboration with key stakeholders Developing, maintaining and updating salary scales and models based on best practices Implementing a job evaluation and grading process Implementing and maintaining payroll processes and practices aimed at ensuring...


  • Durban, South Africa StaffCentral Consulting Full time

    **Job Duties/Responsibilities will include**: **HR Administration**: Delivering, planning, and organising their own work routine and task execution in an effective and efficient manner Preparation of employee information for payroll - ensuring variation information is received and updated timeously and meeting the deadlines Ensuring accurate processing of...


  • Durban, South Africa Featherway Recruiting Full time

    **JOB DESCRIPTION** **CORPORATE ACCOUNTS MANAGER** **FINANCIAL** - **New Scheme Implementations** - Assist with Member Data and Benefit Summaries for New Business Quotations. - Check and submit installation documents to underwriters/administrators on time. - Monitor and manage the installation process within provider SLA. - Provide employer with detailed...


  • Durban, South Africa Mindworx Consulting Full time

    **What were looking for** Employee benefits (EB) have traditionally been the domain of large corporates, with employees of small and medium-sized enterprises (SMEs) left to fend for themselves. The company''s digital group life product has changed all that SMEs can now buy life, disability and / or funeral cover cover for their staff in a matter of minutes....


  • Durban, South Africa Momentum Metropolitan Holdings Full time

    -Introduction Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by...


  • Durban, KwaZulu-Natal, South Africa AECOM Full time

    Company OverviewAECOM is the world's trusted infrastructure consulting firm, delivering professional services throughout the project lifecycle. Our expertise spans transportation, buildings, water, new energy, and the environment.We provide a wide array of compensation, benefits, and well-being programs to meet the diverse needs of our employees and their...


  • Durban, KwaZulu-Natal, South Africa Elite Recruitments Full time

    Join Our Team As An Automotive Sales ConsultantWe are seeking a highly skilled and experienced automotive sales consultant to join our team at Elite Recruitments in Durban.About The PositionThe successful candidate will be responsible for selling new and pre-owned vehicles, building relationships with customers, and achieving sales targets.Key RequirementsA...

  • Liaison Officer

    1 week ago


    Durban, South Africa Independent HR Consultant Full time

    **Liaison Officer**: 1. Sending weekly / bi-weekly expert outstanding lists 2. Resolving all queries related to expert 3. Follow up with expert on overdue/urgent reports and ensure submission by specific due dates 4. Allocation of patient days - preps and interviews 5. Allocation of reports to be typed 6. Management of expert schedule 7. Prioritising...


  • Durban, South Africa Armstrong Appointments Full time

    Durban - Posted 2 hours ago Consulting Engineering Company based in Westville Durban is looking for **a Professional Civil** engineer with at least 5 years post registration experience in a consulting environment. - Experience in civil projects and structural design. - Experience of leading design team. - Experience in running projects. - Client interface...


  • Durban, KwaZulu-Natal, South Africa Balluff South Africa Full time

    About the PositionWe are seeking a highly experienced Automation Systems Consultant to join our team. As an Automation Systems Consultant, you will be responsible for designing and implementing customized automation solutions for our clients.Key Responsibilities:Develop and maintain strong relationships with existing and potential customers.Design and...

  • Business Consultant

    2 weeks ago


    Durban, South Africa LIPCO Business Full time

    VACANCY - DIRECT SALES CONSULTANTS: Short Term Insurance Are you passionate about Sales, target driven & can sell anything to anyone? We are talking to you! We are looking for FAIS compliant reps to sell our legal policies countrywide. Should you want to take control of your finances with a lucrative commission structure as well as other benefits don’t...


  • Durban, South Africa Health Solutions Full time

    **Introduction** - Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by...

  • Sales Consultant

    7 days ago


    Durban, KwaZulu-Natal, South Africa Sanlam Full time

    About the RoleWe are seeking a skilled Sales Consultant to join our team in Durban. As a Sales Consultant, you will be responsible for promoting Sanlam Retail Mass's products and increasing market share through sound financial advice and exceptional client service.Key ResponsibilitiesPromote Sanlam Retail Mass's products and increase market share through...

  • Broker Consultant

    4 days ago


    Durban, South Africa The Recruitment Council Full time

    Our client is looking for passionate, tech-savvy broker consultants looking to challenge the status quo and make a positive impact on brokers and their customers. Specific responsibilities include supporting the development of the client’s broker proposition, attracting, onboarding, activating and supporting independent brokers, and ultimately driving...


  • Durban, South Africa Aon Corporation Full time

    Posting Description: **Healthcare Consultant - Durban** Live in KZN? Extensive Healthcare Consultant experience? We have an opportunity for you! Aon South Africa is recruiting a Healthcare Consultant in our Employee Benefits department, based on a hybrid basis from our offices in Durban. **Aon is in the business of better decisions** At Aon, we shape...


  • Durban, KwaZulu-Natal, South Africa SALT Full time

    Job OverviewWe are seeking a highly skilled Implementation & Consulting Specialist to join our dynamic team. As an Implementation & Consulting Specialist, you will play a key role in providing field and remote support, consultation, and implementations to clients.Main Purpose of Role:You will assist clients globally with their implementation needs, focusing...