- To accurately review and assess In Hospital related queries and updates, in line with Discovery Health products and in accordance with benefit entry criteria and established protocols
The successful applicant will be responsible for but not limited to the following job functions:
- Dealing with all IH queries and escalations through to resolution
- Enforcing policy, protocol and benefits decisions
- Meeting daily Operational Targets, TWT, etc.
- Ad Hoc duties based on business requirements
- Communicating effectively and accurately, progress, outcomes to complainants verbally and in writing
- To liaise with relevant stakeholders involved in the member's care to ensure the best possible member journey.
- Adapts interpersonal style to suit different people or situations
- Adapts to changing circumstances
- Assertive and confident
- Attention to detail
- Customer focused
- Demonstrates integrity
- Shows urgency and passion for servicing
The successful candidate must demonstrate the following competencies:
- Ensures accountability.
- Action oriented
- Manages ambiguity.
- Attracts top talent.
- Business insight
- Collaborates
- Communicates effectively.
- Manages complexity.
- Manages conflict.
- Courage
- Customer focus
- Decision quality
- Develops talent
- Values differences
- Directs work.
- Drives engagement
- Financial acumen
- Global perspective
- Cultivates innovation.
- Interpersonal savvy
- Builds networks.
- Nimble learning
- Organizational savvy
- Persuades
- Plans and aligns.
- Being resilient
- Resourcefulness
- Drives results
- Demonstrates self-awareness.
- Self-development
- Situational adaptability
- Balances stakeholders
- Strategic mindset
- Builds effective teams.
- Tech savvy
- Instils trust.
- Drives vision and purpose
- Optimizes work processes
Education and Experience:
The following requirements are essential:
- Matric
- Nursing Qualification (Enrolled/Professional Nurse)
- Valid SANC Registration
- Discovery Health working experience in a clinical role
- Discovery Health products and system knowledge
- PMB Legislation Knowledge
- Analytical Skills
- Effective Communication Skills (Written & Verbal)
- MS Office
The following requirements are advantageous:
- 1 year CRM Experience
- Discovery Health Pre-Authorizations working experience
Personal Attributes or Competency Profile
- Values Driven
- Optimistic
- Learns on the Fly
- Resilient
- Instils Trust
- People Savvy
- Drives Results
- Problem Solver