Case Manager

2 weeks ago

Bryanston Gauteng, South Africa Unity Health Full time R180 000 - R250 000 per year

Case Manager

Unity Health is a well-established primary healthcare provider in the South African market. Our mission is to offer primary healthcare insurance solutions to the vast majority of South Africans who are unable to afford medical scheme coverage. We have an opening for a Case Manager to join our Clinical team who will be the liaison between Unity Health, providers, and members.

Qualifications:

  • Matric
  • Registered Nursing diploma
  • Valid membership of SANC
  • RE5 (advantageous)

Skills and Experience:

  • At least 2-3 years' experience in a similar role
  • MIP Application System experience an advantage
  • Sound understanding of the South African Health Industry, benefits, etc.
  • ICD codes, modifiers and RPL tariff knowledge and understanding
  • Ability to liaise with external parties – clinicians and members
  • Ability to work within an established team
  • Excellent oral and written communication skills
  • Customer centric attitude
  • Excellent analytical skills and pays attention to detail
  • Computer literate - MS Office suite, i.e., Word, Excel
  • A good understanding of claims risk profiling
  • Experience in claims auditing.

Scope of Responsibility:

  • Responsible for incoming calls from Hospitals Case Managers relating to authorisations for procedures in hospitals, casualty, doctors, or dental providers rooms
  • Hospital case management from issuing a pre-authorisation letter to final discharge and any follow up treatment where required
  • Manage clinical risk by promoting sound principles and strategies to decrease claims over utilisation
  • Pre-authorisation of GP visits per benefit option rules
  • Classify and prioritise risks based on the frequency of member visits to a provider
  • Ensure efficient Customer Service and compliance to agreed SLA's
  • Follow up with healthcare practitioners and members who may be over utilising
  • Manage and maintain data integrity and update accordingly where necessary
  • Ensure all enquiries are resolved satisfactorily and customer requirements within business rules and costing factors are maintained
  • Weekly review of all approved claims and ensure that all claims are settled according to correct tariffs and procedures
  • Ensure that all calls and cases are fully and clearly recorded on the MIP system
  • Supply all monthly management reports on cases and general case management processes and initiatives
  • Any other duties as assigned by your supervisor from time to time

  • Snr Manager: Case Management

    1 week ago

    Ekurhuleni, Gauteng, South Africa City of Ekurhuleni Full time

    Location- City of Ekurhuleni- Remuneration- R 850 440 to R 1 166 640 - Basic salary per annum (plus benefits)- Assignment Type- Permanent**Minimum Requirements**: - Matric - LLB / B Degree majoring in Labour Law - 8 years relevant managerial experience in labour law & local government or similar environment - Knowledge of all applicable South African...

  • New Business Project Manager

    1 week ago

    Bryanston, Gauteng, South Africa Publicis Groupe Full time R500 000 - R1 000 000 per year

    About Publicis Groupe AfricaPublicis Groupe is a business and marketing transformation partner to the world's biggest brands with 107,000 employees in 100 countries around the world. Publicis Groupe is the world's most valuable agency group, on a mission to become an intelligent system company over the next three years with an ambitious AI strategy.Our model...

  • Head of eCommerce

    3 days ago

    Bryanston, Gauteng, South Africa Publicis Groupe Full time R120 000 - R240 000 per year

    Role overviewThe Head of eCommerce will lead the development and activation of Publicis Media Africa's commerce strategy — connecting media, data, and technology to drive measurable sales growth for clients.This role is central to Publicis' transformation toward commerce-led media, combining deep understanding of South Africa's evolving retail ecosystem...

  • Group Er Manager

    1 week ago

    Bryanston, South Africa Omnia (Pty) LTD Full time

    **Overview**: The Omnia spirit underpins its service ethic, brings innovation to the fore, creates value for its customers and ensures integrity in all that it does. The Omnia Group comprises a balanced and diversified range of complementary chemical services businesses with a broad geographic spread. The Group extracts operational synergies and efficiencies...

  • Senior Key Account Manager

    2 weeks ago

    Bryanston, Gauteng, South Africa 1adb4c34-fce2-449f-8ca3-de846ef7728f Full time R800 000 - R1 200 000 per year

    Job DescriptionSenior Key Account ManagerLocation: Bryanston (Hybrid)We are building a Talent pool for this and similar Commercial roles that will be part of Kimberly Clark's Enterprise Markets (Adult Care, Baby & Child Care, Feminine Care).You're not the person who will settle for just any role. Neither are we. Because we're out to create Better Care for a...

  • Senior Key Account Manager

    2 weeks ago

    Bryanston, Gauteng, South Africa 1adb4c34-fce2-449f-8ca3-de846ef7728f Full time R640 - R1 280 per year

    Job DescriptionSenior Key Account Manager, International Family Care & ProfessionalLocation: Bryanston (Hybrid)We are building a Talent pool for this and similar Commercial roles that will be part of Kimberly Clark's International Family Care & Professionalbusiness — an organization rooted in purpose and innovation that has built a legacy with global...

  • Claims/benefits Withdrawal Manager

    7 days ago

    Gauteng, South Africa Eskom Pension and Provident Fund Full time

    **MANAGE INTERNAL DEPARTMENTAL FUNCTIONS AND PROCESSES** - Develop and implement plans for the section that support Pension Administration and EPPF’s objectives, ensuring optimisation of current business and workflow processes. - all benefit processing activities in accordance with the benefits as defined in the rules of the Fund and applicable...

  • Paralegal

    5 days ago

    Bryanston, South Africa Omnia (Pty) LTD Full time

    **Overview**: Reporting to the Head of Legal, the incumbent will be responsible to assist in a variety of assigned legal projects while acting as counsel on basic issues involving company compliance with governmental and regulatory standards as well as the reviewing legal documentation and providing appropriate action. **Qualifications**: - LLB...

  • Employee Relations Specialist

    1 week ago

    Bryanston, Gauteng, South Africa Nampak Full time R540 000 - R900 000 per year

    Location:Sandton, JohannesburgFunction:Human CapitalSub-Function:Employee RelationsImmediate Superior:Senior Employee Relations ManagerType of Contract:Fixed Term Contract (Maternity Cover)Closing Date:5 December 2025Join Us and Shape the Future of Employee RelationsAre you passionate about creating a workplace where collaboration thrives,and compliance...

  • Senior/technical Programme Manager

    1 week ago

    Bryanston, South Africa ProDevelopment (PTY) LTD Full time

    Our Client a Global Tech firm is seeking a Senior/Technical Programme Manager to join their team Remotely. They offer stability, growth, attractive rates and a great working environment. The technical programme manager will be responsible for the management of all projects within a department. The role is to ensure that project managers have access to and...