Client Relationship Manager

Discovery Limited; Sandton; On-site; ZAR 350,000 - 550,000; Full time

Job summary

Discovery Limited through Discovery Care seeks a Client Relationship Manager in Hospital Case Management. The role focuses on reviewing in-hospital queries, ensuring adherence to benefit criteria, and coordinating with care teams to optimize member journeys.

Applicants should have nursing qualifications with SANC registration, knowledge of PMB legislation, and experience in a clinical Discovery Health setting. Proficiency in MS Office and strong communication are essential.

Qualifications

• Essential nursing qualification with SANC registration.
• Experience in a clinical Discovery Health environment is highly preferred.
• Knowledge of PMB legislation is advantageous.
• Strong analytical and communication skills required.
• Proficiency in MS Office is necessary.

Responsibilities

• Dealing with 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 progress and outcomes to complainants verbally and in writing.
• Liaising with stakeholders involved in the member’s care to ensure the best member journey.

Skills

Analytical Skills

Effective Communication

Education

Nursing Qualification (Enrolled/Professional Nurse)

Valid SANC Registration

Matric

Discovery Health working experience (clinical)

PMB Legislation Knowledge

Tools

MS Office

Job description

Role Specific BehavioursEnsures accountability.

Discovery Care

Client Relationship Manager In Hospital Case Management

About Discovery

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About Discovery Care

Discovery Care, a subsidiary of Discovery Health, comprises of several specialized clinical areas with segmented teams. The Chronic and PMB Management team handles the processing of Chronic and Prescribed Minimum Benefit requests and manages escalated clinical queries. The HIV/Oncology and In-Hospital Case Management teams review clinical cases specific to their areas of expertise. The High Touch team provides hands‑on services and resolves escalated queries for sensitive cases. Additionally, the Hospital Benefit Specialists, as part of field force, are responsible for real‑time risk management and the Care Coordination Services manages the Managed Care programs.

Please take note that this role is open to the below regions:

Gauteng, Eastern Cape and Kwazulu- Natal

Key Purpose

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

Key Outputs

• 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.

Skills

• 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

Competencies

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

• 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

The Discovery Person

• Values Driven
• Optimistic
• Learns on the Fly
• Resilient
• Instils Trust
• People Savvy
• Drives Results
• Problem Solver

Employment Equity

The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply

EMPLOYMENT EQUITY

The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.