Claims Authorisation Specialist – Risk & Payments

Pivot Services; Worcester; On-site; ZAR 180,000 - 260,000; Full time

Job summary

Mediclinic Southern Africa is seeking a dedicated administrator to support authorisation and re-authorisation of patient cases. The role focuses on ensuring claims are fully paid by coordinating with funders, medical aids, and clinicians.

The ideal candidate has Grade 12 and experience with clinical administration. You will work on-site in a fast-paced health environment, handling confidential data and ensuring regulatory compliance.

Qualifications

• Essential education: Grade 12 or equivalent.
• Desired education: None - Funder Contracts; Medical aid requirements/narrations.
• Patient admin programmes on the AS400 system.
• Rules and regulations regarding funder contracts.
• Clinical coding (PMB; Consumer Protection Act; etc.).
• Patient Administration policies and procedures (e.g. confidentiality; visitation of external case managers).
• Daily workflow; managing deviances; coding; and case management processes.

Responsibilities

• Obtain authorisation and re-authorisation for all identified patients to ensure fully paid claims.
• Capture data and communicate to all parties.
• Identify and refer risk cases.

Skills

Authorisation processes

Risk assessment

Data capture

Education

Grade 12

Clinical admin training

Tools

AS400 system

Funder contracts knowledge

Job description

Mediclinic Southern Africa is seeking a dedicated administrator to support authorisation and re-authorisation of patient cases. The role focuses on ensuring claims are fully paid by coordinating with funders, medical aids, and clinicians.

The ideal candidate has Grade 12 and experience with clinical administration. You will work on-site in a fast-paced health environment, handling confidential data and ensuring regulatory compliance.