PMB Specialist

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Business Unit: Discovery Health

Function: Administration and Office Support

Date: 9 Oct 2024

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 and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About Discovery Care

Discovery Care is a subsidiary for Discovery Health - made up of distinct areas with segmented teams – Specialized Claims, responsible for the processing of specialized claims. Chronic and PMB Management, responsible for processing of CIB and PMB requests and escalated clinical query processes while Disease Management-HIV and Oncology and In Hospital Case Management teams are responsible for reviewing clinical cases for each of the specialized areas. High Touch made up of Healthy Company and Client Relationship management functions.

Key Purpose

The processing of out of hospital PMB Psychotherapy applications in line with PMB protocols and in accordance with the benefit entry criteria. To assist and support the PMB Operations team with ad hoc projects and tasks.

Responsibilities:

1. Reviewing PMB Psych application forms from members & providers and making appropriate funding decisions by applying PMB protocols.
2. Working towards daily outputs of production and quality to ensure member satisfaction.
3. Apply government stipulations in terms of PMB’s and treatment algorithms.
4. Communication with members and providers surrounding PMB decision outcomes.
5. Adhoc duties within the PMB team may be required.

Qualifications & Experience

The following requirements are Essential:

1. Matric
2. Administrator, Data Capture or Call Centre experience
3. Medical Scheme or Insurance experience

The following requirements are advantageous:

1. Discovery experience
2. Understanding of DH product benefit, funding and policy rules
3. Discovery systems knowledge
4. Basic Clinical knowledge

EMPLOYMENT EQUITY
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.

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