Job Description
Position: Specialist Authorisation Agent
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 re...