Chronic Benefit Consultant

14 hours ago

Durban, South Africa Momentum Metropolitan Holdings 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

This position will report to the Medicine Risk Manager and is based in Cornubia.

**Requirements**:

- Matric
- Post-Basic Pharmacist assistant qualification is essential
- Previous Health Risk Management experience would be an advantage
- Previous experience in a managed care environment dealing with Health Risk Management would be an advantage
- Registration with the Pharmacy Council as Pharmacist Assistant would be an advantage
- Clinical Knowledge
- Computer literate
- Good telephone etiquette

Duties & Responsibilities
- All interactions, telephonic and written, with members, providers, brokers and internal stakeholders to be professional
- Registration of medicine and/or diagnosis to be done timeously and independently in accordance to MMI Health policies and scheme formularies
- Develop effective relationships and ensure that Service Level Agreements with External clients and internal departments are maintained thus ensuring excellent service to the scheme, members, providers as well as internally
- 24 hour turnaround -; Maintain a consistent and quality 24 hour turnaround time from receipt of documents/calls into the Medicine Risk Management department
- Provide 1st time and timeous resolution on queries
- Provide effective management of a patients disease and lifestyle to promote an integrated and holistic approach to managing the healthcare of a member
- To provide support and assistance to the DUR Pharmacist, DRM, HRM and Clinical Governance departments in terms of medical management and clinical input.
- Ensure effective claims management service delivery and support
- Perform an efficient and accurate administrative function to the team.
- Identify all compliance risks and bring to the attention of the team leader for review.
- Monitor customer delivery constraints and escalate to management
- Identify and investigate all possible non-disclosure of pre-existing conditions
- Identify the appropriate entry criteria and ensure consistent and correct authorizations in line with clinical policies and the relevant scheme rules and formularies
- Have the capacity to develop oneself and others via the various training options thus positively growing oneself and the team.

Competencies
- Customer focused
- Excellent verbal and written Communications Skills
- Good interpersonal skills
- Attention to detail
- Service oriented
- Stress tolerant and working under pressure
- Empathetic
- Proactive
- Highly motivated
- Drive and support effective teamwork within the Department

Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

  • Chronic Benefit Consultant

    7 days ago

    Durban, South Africa Momentum Metropolitan Holdings 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...

  • Chronic Benefit Consultant

    14 hours ago

    Durban, South Africa Momentum Metropolitan Holdings 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...

  • Hospital Benefit Specialist

    7 days ago

    Durban, South Africa Medical Aid, Bank, Insurance, Invest & Vitality Full time

    Hospital Benefit Specialist - KZN 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...

  • Hospital Benefit Specialist

    4 weeks ago

    Durban, South Africa Discovery Full time

    Hospital Benefit Specialist - KZN 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...

  • Hospital Benefit Specialist

    15 hours ago

    Durban, South Africa Discovery Ltd. Full time

    **Business Unit**:Discovery Health **Function**:Clinical **Date**:26 Feb 2025 **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...

  • Hospital Benefit Specialist

    2 weeks ago

    Durban, South Africa Medical Aid, Bank, Insurance, Invest & Vitality Full time

    Hospital Benefit Specialist About Discovery Discoverys 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...

  • Benefits Lead

    3 days ago

    Durban, South Africa Unilever Full time

    Role Purpose: - The Benefits Lead plays a strategic role in leading the newly created Africa Benefits Hub team and will centrally co-ordinate key Benefits activities for the Africa cluster. This is a highly complex role, with each country having a unique set of benefits that will need to be applied with a high level of rigour, co-ordination and compliance...

  • Total Reward Leader

    1 week ago

    Durban, South Africa Transnet Company Full time

    A South African logistics firm is seeking a Senior Manager for Remuneration & Benefits in Durban. The role involves developing compensation strategies to attract and retain talent, managing salary parity, and overseeing performance management systems. Candidates should have a degree in Human Resources or related fields, with 8-10 years of experience in HR,...

  • Senior Manager: Remuneration

    3 weeks ago

    Durban, South Africa Transnet Company Full time

    Senior Manager: Remuneration & Benefits Operating Division: Transnet Pipelines Employee Group: Permanent Department: HR, Remuneration, DNR Location: Durban Central Reporting To: Head: People Management Grade: E Reference: req3734 Position Purpose Provides input in the design and development of Transnet Total Reward (Remuneration, Organisation Management and...

  • Pre-Auth Service Specialist — Patient Care

    2 weeks ago

    Durban, South Africa Discovery Limited Full time

    A leading health services provider in Durban seeks a Pre-Auth Service Consultant to deliver top-notch service to health members and providers. The role entails confirming benefits, resolving queries, and exceeding performance metrics in a dynamic environment. Ideal candidates should have a matric and a clinical qualification, alongside 6 months of relevant...