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Healthcare Services Coordinator

2 weeks ago

Pretoria, Gauteng, South Africa Bestmed Medical Scheme Full time

About Us

Bestmed Medical Scheme is a non-profit, mutual medical scheme registered with the Council for Medical Schemes. We have been providing healthcare to the lives of South Africans for over 60 years.

We are committed to creating a culture where we can all contribute in our unique way to make Bestmed the best employer for our talent. We optimize individuals to contribute their best version of themselves in a performance enabling environment.

Job Duties

  • 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.

Essential 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.