Pre Auth Consultant (Talent Pool)
Financial Services, Insurance
Minimum Requirements
- Matric
- Registered/ Enrolled Nurse is advantageous
- 2-3 years’ Experience within the managed care industry.
- Excellent understanding of the scheme products and legislation.
- Effective management of scheme rules in line with clinical guidelines.
- Knowledge of PMB guidelines.
- Telephonic etiquette.
- Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group.
- Anticipates, meets and exceeds client's needs by creating long lasting relationships that support the client value proposition,supports their financial wellness and ensures client centricity.
- Drive a sense of urgency, focus,accountability, agility and execution to deliver business results.
- Actively leads change, does what is right for the business and drives continuous improvement through8 innovation.
- Prioritises the business interests of MMH and invests in the success of the group by aligning effort across divisions.
- Persuades, convinces, influences and inspires others, both within MMH and externally to win support,loyalty and gain commitment to the purpose of MMH.
- Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations. Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
- Attain daily KPI of 70 –;meet the prescribed number of calls(240 seconds Handling time per call).
- Maintain quality customer service.
- Bin management turn-around time of 48 hours.
- Implementation of policies / protocols related to scheme benefits.
- Benefits in and out of hospitalis appropriately controlled.
- Exclusions are correctly and consistently applied.
- Positive relationships are built and maintained with hospitals and providers.
- Appropriate referral to case management team.
- within the managed care industry.
Responsibilities
- Attain daily KPI of 70 –;meet the prescribed number of calls(240 seconds Handling time per call).
- Maintain quality customer service.
- Bin management turn-around time of 48 hours.
- Implementation of policies / protocols related to scheme benefits.
- Benefits in and out of hospitalis appropriately controlled.
- Exclusions are correctly and consistently applied.
- Positive relationships are built and maintained with hospitals and providers.
- Appropriate referral to case management team.
