CASE ADMINISTRATOR - CASE MANAGEMENT

joint-medical-holdings; Durban; On-site; ZAR 180,000 - 240,000; Full time

Job summary

Joint Medical Holdings in Durban, South Africa, is seeking a Case Administrator to support the Case Management function from admission to discharge and account submission. You will manage medical-aid information, authorisations and billing documentation to improve cash flow and reduce rejections.

Requirements include Grade 12/Matric and experience in private hospital administration or billing. Proficiency in Microsoft Office and hospital information systems is advantageous.

Qualifications

• Knowledge of medical-aid processes and funding requirements.
• Experience with hospital patient administration and billing workflows.
• Basic computer skills and familiarity with hospital information systems.

Responsibilities

• Obtain and verify medical-aid membership, benefits and pre-authorizations.
• Follow up outstanding authorizations, extensions and funding needs.
• Assist with daily patient-in-progress reporting and documentation.
• Gather missing clinical and administrative information for finalizing accounts.
• Ensure patient accounts are complete and minimise claim delays.
• Liaise with Billing, Bill Audit and Case Management on outstanding items.
• Monitor medical-aid claim rejections and resolve queries.
• Track long-stay and high-value patients and update funding details.
• Maintain accurate case-management records and timely reporting.
• Adhere to hospital policies and confidentiality standards.

Skills

Medical-aid processes

Hospital patient administration

Authorisations

Billing awareness

Computer literacy

Education

Grade 12 / Matric

Tools

Hospital information systems

Job description

PURPOSE OF POSITION

The Case Administrator provides administrative and financial support to the Case Management function, ensuring patient cases are accurately managed from admission through to discharge and account submission. The role ensures medical-aid information, authorisations, clinical updates and account documentation are followed up timeously, contributing to accurate billing, reduced claim rejections, improved cash flow and effective debtor management.

KEY PERFORMANCE AREAS

• Obtain and verify medical-aid membership, benefits and required pre-authorizations.
• Follow up outstanding authorizations, extensions and funding requirements.
• Assist with daily patient-in-progress reporting and ensure required documentation is obtained.
• Follow up outstanding clinical and administrative information required for account finalization.
• Ensure patient accounts are complete and identify information that may result in claim rejection or payment delays.
• Liaise with Billing, Bill Audit and Case Management regarding outstanding account requirements and billing queries.
• Monitor medical-aid claim rejections and queries and obtain information required for resolution.
• Monitor patients who remain in hospital, including long‑stay and high‑value cases, and ensure funding information is current.
• Maintain accurate case‑management records and reports and ensure information is captured timeously.
• Adhere to hospital policies, medical‑scheme requirements, confidentiality standards and agreed turnaround times.

MINIMUM REQUIREMENTS

• Grade 12 / Matric.
• Previous experience in a private hospital, medical‑aid, healthcare administration, billing or case‑management environment.
• Knowledge of medical‑aid processes and hospital patient administration.
• Understanding of authorisations, medical‑aid benefits and funding requirements.
• Basic understanding of hospital billing and account submission processes.
• Computer literacy, including Microsoft Office.
• Experience with hospital information systems would be advantageous.

NB: Only short‑listed candidates will be contacted.
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