Job Description
Location: Centurion, Gauteng
Position Purpose: To ensure the accurate issuing of appropriate pre-authorisations that meet the requirements of clinical appropriateness, medical necessity and clinical risk management.
Experience: 2 to 5 years’ solid experience within a medical aid administration environment.
Qualifications: Grade 12 and relevant tertiary qualification. KEY PERFORMANCE AREAS Handle inbound and outbound calls relating to pre-authorisation requests. Capture, validate, and process benefit authorisations accurately. Liaise with members, healthcare providers, and internal stakeholders to ensure efficient service delivery. Provide clear and professional communication regarding benefit limits, exclusions, and scheme rules. Escalate complex queries to the clinical team where required. Maintain accurate records and adhere to company policies, procedures, and service level agreements. KEY COMPETENCIES
Skills and Abilities Atte...