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Pre-Auth Consultant

2 weeks ago

Roodepoort, Gauteng, South Africa AfroCentric Group Full time R180 000 - R250 000 per year

Position Purpose
:

Providing Customer Experience and is responsible for assisting customers' needs. Through their engagements with the customer, they will need to build trust and connection and resolve requests with acknowledgement and care. Growing and maintaining knowledge and understanding of the customer journey and their emotional reactions. Delivering and enable excellence in all service moments to all stakeholders (Members, Providers, Employer groups, Intermediaries, Schemes). Providing personalised clinical servicing through the omni channel experience focusing on the overall care quality of interaction between our customers and the brand. Providing holistic care that is personalised and accessible, managing the care journey end to end. Committing to our service care charter striving to continuously make a positive difference.

Experience
:

1-2 years Managed Care Operations Experience

1-2 years Customer Servicing Experience

2-3 years General and Surgical Ward Experience

1-2 years Managed Health Care Experience (Call Centre) Advantageous

1-2 years Trauma / ER Experience Advantageous

Qualifications
:

Registered in Nursing services, plus registration with SA Nursing Council

Client service delivery and quality

  • Follow procedures and cooperate with peers and leader for best possible service delivery

Compliance and Risk Management

  • Defined legal, statutory and regulatory compliance is maintained at the required standards

  • Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary

Operating Model

  • Meet delivery objectives through working with other team memberswithin and linked to the department / project

  • Resolve operational performance variations and problems and escalate unresolved issues to higher levels

  • Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery

Operational Implementation of Strategy

  • Keep up to date with operational changes implemented in response to important external influences

  • Deliver in a manner that supports and meets operational quality standards and meets the defined departmental priorities

  • Perform according to defined operational best practice and identify and implement opportunities for continuous delivery improvement

Operational Leadership

  • Deliver personal performance within Human Capital frameworks and policies to ensure delivery to agreed standards and objectives

  • Engage in development, coaching and mentoring

  • Support transformation through valuing diversity

  • Behave in alignment with the Afrocentric values

Stakeholder Management

  • Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achieved

  • Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-in

Generic Objectives

Manage Care Service Requests:

Service all key stakeholders in the moment across all servicing channels as required until the clinical service request has been resolved.

Educate stakeholders on self

-help digital servicing tools. Connect with your customers (all stakeholders) across all channels, enabling an intuitive

experience and bringing across our brand authentically. Provide a seamless, progressive and holistic approach, understanding the customer's needs.

Manage Authorisations:

Manage and or validate the customer's authorisations needs with care, understanding and empathy. Caring holistically for the patient journey.

Manage Excellent Experiences:

Provide accurate and consistent information, meeting all quality standards and measures.

Deliver excellence in customer satisfaction.

Strive to identify areas of improvement and sharing of ideas with your team.

Collaborate with all teams to enable peer to peer learning.

Drive Brand Loyalty:

Be a brand ambassador, allowing the brand presence to be felt as an extension of the experience.

Knowledge

-Customer service operations

-Health legislation and regulatory

-Health Care Environment and Facilities

-Health Care Industry

Turnaround Time

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of line managers.

Our Commitment to Transformation

AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create

Should you not receive feedback within a month of applying, please consider your application unsuccessful