Chronic Benefit Consultant

6 days ago


Durban, South Africa La Lucia Healthcare Hospital Full time

**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 La Lucia Hospital 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 oriental
- Stress tolerant and working under pressure
- Empathetic
- Proactive
- Highly motivated
- Drive and support effective teamwork within the Department

**Job Types**: Full-time, Permanent

**Salary**: R15,000.00 - R32,000.00 per month

**Education**:

- Certificate (preferred)

**Experience**:

- Pharmacy software (preferred)



  • 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...


  • 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...


  • Durban, South Africa Discovery Limited 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,...


  • Durban, South Africa Sanlam Full time

    **Who are we?** Simeka Consultants and Actuaries (Simeka) is a consulting and advisory business in the employee benefits industry. We offer innovative solutions and services to a wide range of clients encompassing retirement funds, employers, medical scheme members, trade unions and members of retirement funds. Our goal is to continue assessing and...

  • Employee Benefits

    2 weeks ago


    Durban, South Africa Afrizan People Intelligence Full time

    **JOB DESCRIPTION** **Our client in the Benefit Fund Administration Industry is looking for enthusiastic and passionate Claims Consultants, with experience dealing with Death, Retirement and Trust Claims. The purpose of this role would be to provide specialist advise and support ensuring that claims are paid out as accurately and timeously as...

  • Total Reward Leader

    4 weeks 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,...


  • 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...

  • Call Centre Agent

    2 weeks ago


    Durban, South Africa Sisiwe Business Consultant Full time

    **MAIN PURPOSE OF THE ROLE**: - Present, promote and sell products/services using solid arguments to existing and prospective customers - Perform cost-benefit and needs analysis of existing/potential customers to meet their needs - Establish, develop and maintain positive business and customer relationships - Reach out to customer leads through cold...

  • Call Centre Agent

    2 weeks ago


    Durban, South Africa Sisiwe Business Consultant Full time

    **Role Description** This is a full-time on-site role as a Sales Agent for our client located in Durban. The Sales Agent will be responsible for generating leads, managing client accounts, providing excellent customer service, and closing sales. The Sales Agent will also be responsible for promoting and selling products, and providing training to clients on...


  • Durban, South Africa Bluff Personnel Consultant Full time

    **Main Duties include**: Processing and reviewing of receivables, payables, petty cash, wages, journals, fleet management and ad hoc payments Review financial data for accuracy, correctness and completeness Submission of accurate forecasts regarding expenses and revenue Ensure correct calculation of wage related expenses and benefits Supervise and manage...