Service Consultant: Pre-auth

2 weeks ago

Durban, South Africa Health Solutions Full time

**Introduction**

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.

**Role Purpose**

**Requirements**:

- Matric
- Call centre experience is preferred
- Minimum 1 year medical experience (doctor's rooms, radiology, hospitals, x-rays, paramedics, confirmation clerk) is essential
- Good understanding of anatomy and physiology
- Good telephone etiquette is essential
- Independent thinker
- Knowledge of healthcare industry is preferred

**Duties & Responsibilities**
- Maintain quality customer service
- Bin management -turnaround of 48 hours
- Implementation of policies/protocols related to scheme benefits
- Benefits in and out of hospital is appropriately controlled
- Exclusions are correctly and consistently applied
- Positive relationships are built and maintained with hospitals and providers
- Appropriate referral to case management team

**Competencies**
- Accountability
- Takes responsibility for own work
- Planning Skills
- Customer orientation
- Organization and Attention to Detail
- Is attentive In Basic, Routine, Repetitious Tasks
- Interrelationship skills
- Possess good judgment and decision-making skills.
- Ability to engage people.
- Demonstrates initiative.
- Understands the organization
- Business Writing Skills
- Product Knowledge
- Risk knowledge - Demonstrates knowledge and understanding of risk management methodologies, tools, governance structures and regulatory requirements for good management of risk.

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