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Pre-Authorization Specialist

1 week ago

Pretoria, Gauteng, South Africa Bestmed Medical Scheme Full time

Our Mission

At Bestmed Medical Scheme, we are committed to ensuring that all employees have opportunities for professional development, fair compensation and employee benefits. We strive to create a congenial and collegial work environment where innovation is welcomed and encouraged.

We reinforce a culture of zero tolerance towards any forms of inappropriate behaviour, abuse (including abuse of power, privilege or trust), harassment, or exploitation of any kind to safeguard our members, employees and partners.

Job Responsibilities

  • Delivering cost-effective managed healthcare services to achieve member satisfaction.
  • Client Relations: Approving appropriate funding for clients.
  • Providing effective call centre service to achieve member satisfaction.
  • Risk Management: Reducing risks associated with hospital and authorized cases.
  • Telephone Etiquette: Answering telephone calls to achieve member satisfaction.
  • Verifying prosthesis limits to contain costs for both members and fund.
  • On-going training and development to update knowledge and skills to deliver a cost-effective and professional service.
  • Ensuring actual benefit expenditure per beneficiary per month for hospitalization is less than budgeted expenditure. Pre-authorization should be granted within option benefits, Scheme and clinical protocols.
  • Effective Customer Service Delivery: Delivering an effective call centre service to achieve member satisfaction.
  • Delivering a cost-effective Managed Healthcare service.

Benefits

We offer an exceptional benefit programme and competitive packages, including 23 days annual leave and a workday of only 8 hours, including a 30 min break. Permanent employees have access to development opportunities, life cover, disability benefits, funeral cover, pension fund, medical aid and more. Office benefits include free parking, free Wi-Fi, landline phone allowance, and free refreshments.

Requirements

  • Grade 12
  • Enrolled Nursing

Experience - Essential

  • Minimum 5 years experience as a nursing practitioner.
  • Minimum 1 year experience gained in the medical funding industry.