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

• Attention to Detail – ensures accuracy in capturing and processing data.
• Customer Service Orientation – professional, empathetic, and solution-driven approach.
• Problem-Solving – able to resolve queries effectively within policy guidelines.
• Time Management – manages workload efficiently and meets deadlines.
• Teamwork & Collaboration – works well with colleagues and supports a positive team culture.
• Adaptability – remains resilient and focused in a fast-paced environment

 Knowledge

• Knowledge of medical aid rules, ICD-10 codes.
• Strong computer literacy and data-capturing skills.
• Excellent communication skills (verbal and written).
• Ability to work in a structured, high-volume call centre environment
• Knowledge and application of relevant legislation
• Knowledge and application of scheme rules

 Note: Company reserves the right to close the advert before specified closing date.