Clinical Authorisation Specialist

2 weeks ago


Johannesburg, Gauteng, South Africa Palesa Mbali Group Full time
About Palesa Mbali Group

Palesa Mbali Group is a dynamic organisation seeking a highly skilled Clinical Authorisation Specialist to join our pre-authorisation call centre team.

Job Summary

We are looking for a detail-oriented and customer-focused individual with a strong background in nursing and experience in clinical authorisation. The ideal candidate will possess excellent communication skills, be able to work under pressure, and have a keen eye for accuracy.

Key Responsibilities
  • Authorise hospital authorisation requests by applying coding principles, medical scheme rules and benefits, and managed care policies and processes.
  • Capture accurate pre-authorisation data on the system
  • Educate and assist members by providing relevant clinical information to access the correct clinical benefits
  • Consult members' healthcare professionals to make informed clinical decisions and manage financial risk
  • Correctly escalate complex clinical calls
  • Provide exceptional customer service
  • Address all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in
Requirements
  • Formal nursing qualification (SANC enrolled nurse) – required
  • 2-3 years' experience in a general medical or general surgical ward, with at least 1 year at a private institution
  • Trauma/ER experience will be an advantage
  • Previous managed healthcare experience in a call centre environment – advantageous
Salary and Benefits

The successful candidate can expect a competitive salary of R250,000 - R350,000 per annum, depending on experience, as well as a range of benefits including medical aid, pension fund, and generous leave provisions.



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