Case Management Specialist

3 weeks ago


Sandton, South Africa Taylored Appointments Full time

You will be reporting to the Case Management Lead.

**Your key responsibilities will be**:

- Submission of relevant documentation to medical funders for authorizations
- Own and create the relationship with Medical Aid Schemes
- Collection of relevant documentation from consumers and/or their healthcare practitioners
- Following-up on cases out of scheme turnaround time
- Review funding outcomes on a case-by-case basis, within the bounds of protocols and escalate those that are insufficient
- Monitoring and gaining an understanding of the evolution of medical aid plans
- Explaining funding outcomes to consumers as they are received and in accordance with SOP
- Logging consumer complaints in the CRM system timeously and following up with the necessary action
- Ensuring all case management interactions are recorded in the CRM system as per SOP
- Ensuring completeness and accuracy of case management tasks
- Responsible for case management outcomes and the investigation of any incomplete cases
- Answering of inbound case management related telephone calls
- Any other case management-related ad-hoc tasks
**Professional qualifications**:

- At least two years of working experience
- Tertiary qualification is an advantage
- Previous experience in a medical field is an advantage
- Previous case management or medical aid experience is advantageous
- ICD 10 coding knowledge is advantageous



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