Call Centre Nurse Consultant

Unity Health; Gauteng; On-site; ZAR 300 000 - 400 000; Full time

Job summary

A primary healthcare provider in Gauteng seeks a Call Centre Nurse Consultant to deliver exceptional managed healthcare services. Key responsibilities include handling incoming calls, clinically assessing members, and ensuring customer satisfaction. Candidates must have a Matric qualification, be an enrolled nurse, and possess strong management skills. Experience in the South African Health Industry is essential for success in this role.

Qualifications

• At least 2–3 years’ experience in a similar role.
• Valid membership of SANC or significant progress toward it is advantageous.
• Sound understanding of the South African Health Industry.

Responsibilities

• Deliver a cost‑effective Managed Healthcare service.
• Handle incoming calls from Network GP rooms and members.
• Clinically assess members and triage accordingly.

Skills

Excellent clinical and risk management knowledge

Customer‑centric attitude

Excellent analytical skills and pays attention to detail

Excellent oral and written communication skills

Ability to liaise with external parties

Education

Matric qualification

Enrolled Nurse or Enrolled Nursing Auxiliary

Tools

MIP Application System

MS Office suite (Word, Excel, PowerPoint, Outlook)

Job description

Call Centre Nurse Consultant

Overview

Unity Health is a well‑established primary healthcare provider in the South African market.

Our mission is to offer primary healthcare insurance solutions to the vast majority of South Africans who are unable to afford medical scheme coverage.

Scope of Responsibility

• Deliver a cost‑effective Managed Healthcare service.
• Provide effective customer service delivery.
• Deliver an effective call centre service to achieve member satisfaction.
• Handle incoming calls from Network GP rooms and members.
• Clinically assess members and triage accordingly.
• Where triage allows, pre‑authorise for a physical GP consultation.
• If triage does not allow a physical GP consultation, refer the member to the correct sub‑category (e.g., Intercare, Pharmacy Nurse Clinic, Reality Wellness).
• Manage clinical risk by promoting sound principles and strategies to decrease GP claims over‑utilisation.
• Perform clinical audits on authorised GP claims and ensure ICD‑10 codes match the symptoms provided.
• Classify and prioritise risks based on the frequency of member visits to a provider.
• Ensure efficient customer service and compliance with agreed Service Level Agreements (SLAs).
• Manage and maintain data integrity and update accordingly where necessary.
• Ensure all enquiries are resolved according to the business standard business rules, while maintaining costing factors.
• Ensure that all calls and cases are fully and clearly recorded on the MIP system accordingly.
• Escalate any concerns or matters that will result in unsatisfied customer service.
• Perform any other duties as assigned by your manager from time to time.
• Report to the Nurse Call Centre Supervisor.

Qualifications & Skills

• Matric qualification.
• Enrolled Nurse or Enrolled Nursing Auxiliary.
• Valid membership of SANC, FAIS compliant or significant progress toward (advantageous).
• At least 2–3 years’ experience in a similar role.
• Excellent clinical and risk management knowledge.
• Experience with MIP Application System (advantage).
• Sound understanding of the South African Health Industry, benefits, etc.
• Knowledge of ICD codes, modifiers and RPL tariff.
• Ability to liaise with external parties – clinicians and members.
• Ability to work within an established team.
• Excellent oral and written communication skills.
• Customer‑centric attitude.
• Excellent analytical skills and pays attention to detail.
• Computer literate – MS Office suite (Word, Excel, PowerPoint, Outlook).
• Ability to lead a team with minimal supervision.
• Knowledge of the Protection of Personal Information Act (POPIA) and the ability to apply this in customer services.

Changes: The company reserves the right to change this job description at its sole discretion from time to time.