Prospective Reviewer

3 days ago


Cape Town City Centre, South Africa Jobted ZA C2 Full time

Prospective Reviewer (Pre-Authorization Call Centre)

The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met.

Key Activities:

- Authorizing hospital authorization 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 member by providing relevant clinical information to access the correct clinical benefits
- Consult member's health care professional to make informed clinical decisions and manage financial risk
- Correctly escalate complex clinical call
- Provide excellent customer service
- Address all customer complaints in alignment with policies and procedures to achieve stakeholder buy-in

Education and Experience:

- 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
- Minimum of 3 years in the clinical space required
- Must be computer literate
- Call centre experience advantageous
- Previous Managed Healthcare experience in a call centre environment – advantageous

Company Description:

A highly respected company with many of the top medical schemes under their umbrella


  • Prospective Reviewer

    4 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    **Prospective Reviewer (Pre-Authorization Call Centre)** The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. **Key Activities**: - Capture accurate...

  • Prospective Reviewer

    4 weeks ago


    Cape Town, South Africa Adzuna ZA B C2 Full time

    Prospective Reviewer (Pre-Authorization Call Centre) The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. Key Activities:Authorizing hospital authorization requests...

  • Prospective Reviewer

    4 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    Prospective Reviewer (Pre-Authorization Call Centre) The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. Key Activities:Authorizing hospital authorization requests...

  • Prospective Reviewer

    4 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    Prospective Reviewer (Pre-Authorization Call Centre) The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met. Key Activities:Authorizing hospital authorization requests...

  • Prospective Reviewer

    4 weeks ago


    Cape Town, South Africa Palesa Mbali Group Full time

    Prospective Reviewer (Pre-Authorization Call Centre)   The Prospective Reviewer role within the pre-authorization call centre, is responsible for authorizing hospital authorization requests ensuring that requirements of clinical appropriateness, medical necessity and clinical risk management are met.   Key Activities: Authorizing hospital authorization...

  • Prospective Reviewer

    4 months ago


    Cape Town, South Africa WNS Global Services Full time

    Company Description **WNS (Holdings) Limited (NYSE: WNS)** is a global Business Process Management (BPM) leader. WNS offers business value to 400+ global clients by combining operational excellence with deep domain expertise in key industry verticals, including Banking and Financial Services, Consulting and Professional Services, Healthcare, Insurance,...


  • Cape Town, South Africa Vantage Debt Managment Full time

    Vantage Debt Management is a newly established company with the mission to educate and assist South Africans to better understand and improve their financial circumstances. Vantage is looking for ambitious, energetic and intelligent individuals to join its growing team. Be a part of a young and exciting start-up in the financial services industry. If you...


  • Cape Town, South Africa Vantage Debt Management Full time

    Vantage is looking for ambitious, energetic, and intelligent individuals to join its growing team. Be a part of a young and exciting start-up in the financial services industry. If you are interested in making a positive impact on people’s lives and growing your finance career at the same time, this is the opportunity for you. **Responsibilities...


  • Cape Town, South Africa Vantage Debt Management Full time

    Vantage is looking for ambitious, energetic, and intelligent individuals to join its growing team. Be a part of a young and exciting start-up in the financial services industry. If you are interested in making a positive impact on people’s lives and growing your finance career at the same time, this is the opportunity for you. **Responsibilities...


  • Cape Town, South Africa Vantage Debt Management Full time

    Vantage is looking for ambitious, energetic, and intelligent individuals to join its growing team. Be a part of a young and exciting start-up in the financial services industry. If you are interested in making a positive impact on people’s lives and growing your finance career at the same time, this is the opportunity for you. **Responsibilities...


  • Cape Town City Centre, South Africa Jobted ZA C2 Full time

    Experience: Matric and 2-3 years sales experience in the healthcare sector Own transport is essential Good working knowledge of the State and Private Hospital buying process Good understanding of Key Opinion Leader influence Experience using the Microsoft Office Tools and presentation skills Duties: Serves customers by selling products; meeting customer...


  • Cape Town City Centre, South Africa Jobted ZA C2 Full time

    Applicants are required to meet the following criteria: - Technical Diploma or Degree as well as sales courses / diploma or continuous development - > 3 years' experience in Key Accounts Management and Solar PV technologies - Sales Background / Advanced Selling / Key Accounts Management / Customer Centric Approach / Client Relationship Skills - High level...


  • Cape Town, South Africa Voyc Full time

    Voyc is an award-winning conversation intelligence and compliance monitoring software specifically developed for financial services firms’ contact centes. Voyc helps financial services companies be compliant and improve customer service by monitoring 100% of their customer interactions. Voyc uses AI to transcribe, automatically analyse and review customer...

  • Lead Generator

    4 months ago


    Cape Town, South Africa National Debt Advisors Full time

    **National Debt Advisor is looking for a Lead Generator to join their team!!!** **Job title: Lead Generator** **Department: Sales** **Position type: Full time** As a **Lead Generator**, your role is to dial and find potential qualifying clients for debt review, prospecting process, needs analysis, and client report building, and find the ideal potential...


  • Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    Job Title: Prospective ReviewerAt Palesa Mbali Group, we are seeking a highly skilled and experienced Prospective Reviewer to join our Pre-Authorization Call Centre team.Key Responsibilities:Authorize hospital authorization requests by applying coding principles, medical scheme rules, and benefits, as well as managed care policies and processes.Capture...


  • Cape Town, South Africa VBO Global (Pty) Ltd. Full time

    We are on the lookout for a **Sales Development Representative** to join a Payment Gateway team within the **FinTech** industry in the heart of Cape Town City. Do you have a passion for Sales combined with Tech? Look no further! **What are we looking for**: - The successful applicant will be responsible for generating a meaningful pipeline by driving...


  • Cape Town, South Africa Boldr Full time

    A LITTLE BIT ABOUT Boldr - Boldr is the first global B-Corp dedicated to delivering world-class Client experiences while creating access to dignified, meaningful work in communities worldwide. - We are a global team, united by our desire to connect diverse people with common values for boldr impact. - We employ just over a thousand team members across five...


  • Cape Town, Western Cape, South Africa Palesa Mbali Group Full time

    Job Title: Prospective ReviewerAt Palesa Mbali Group, we are seeking a highly skilled and experienced Prospective Reviewer to join our Pre-Authorization Call Centre team.Key Responsibilities:Authorize hospital authorization requests by applying coding principles, medical scheme rules, and benefits, and managed care policies and processes.Capture accurate...

  • Sales Team Leader

    4 months ago


    Century City, South Africa Magnus Marketing Full time

    Magnus Marketing, is a cutting-edge Fin-Tech powerhouse specializing in international financial markets and portfolio management. We are on the lookout for exceptional talent to thrive in our fast-paced, fiercely competitive environment. Are you ready to take your career to the next level? If so, we are seeking a dynamic and experienced Sales team leader to...

  • Sales Agent

    6 days ago


    Cape Town, South Africa Debtabate Full time

    As a Debt Review Sales Agent, you will play a crucial role in generating new business by identifying potential clients who could benefit from our debt review services. You will be responsible for explaining the benefits of debt review, guiding clients through the process, and closing sales. **Key Responsibilities**: Explain the debt review process and its...