Pre Authorisation Consultant

AfroCentric Group; Wes-Kaap; On-site; ZAR 250 000 - 400 000; Full time

Job summary

A leading healthcare provider in South Africa is seeking a Registered Nurse to enhance customer service delivery and quality. The role involves managing client interactions, ensuring compliance, and supporting operational excellence while engaging in continuous improvement. Candidates should have relevant nursing qualifications and experience in managed care operations.

Qualifications

• 1-2 years Managed Care Operations Experience.
• 1-2 years Customer Service Experience.
• 2-3 years General and Surgical Ward Experience.

Responsibilities

• Ensure compliance with legal, statutory, and regulatory standards.
• Contribute to cost savings and support financial goals.
• Maintain active relationships with customers and stakeholders.

Skills

Customer Service

Stakeholder Management

Compliance

Operational Leadership

Education

Registered Nurse with registration with the SA Nursing Council

Job description

Providing Customer Experience and is responsible for assisting customers’ needs. Through their engagements with the customer, they will need to build trust and connection and resolve requests with acknowledgement and care. Growing and maintaining knowledge and understanding of the customer journey and their emotional reactions. Delivering and enabling excellence in all service moments to all stakeholders (Members, Providers, Employer groups, Intermediaries, Schemes). Providing personalised clinical servicing through the omni-channel experience focusing on the overall care quality of interaction between our customers and the brand. Providing holistic care that is personalised and accessible, managing the care journey end to end. Committing to our service care charter striving to continuously make a positive difference.

Duties & Responsibilities

Accountabilities

Client service delivery and quality:

• Follow procedures and cooperate with peers and leader for best possible service delivery

Compliance and Risk Management:

• Maintain defined legal, statutory, and regulatory compliance at required standards
• Ensure operational risk and governance structures, measures, and frameworks are followed and address issues when necessary

Financial Management:

• Contribute to cost savings within the department to support financial goals and targets

Operating Model:

• Meet delivery objectives by collaborating with team members within and across departments/projects
• Resolve operational performance issues and escalate unresolved problems appropriately
• Ensure delivery targets/objectives are achieved and support successful delivery

Operational Implementation of Strategy:

• Stay updated on operational changes driven by external influences
• Deliver services that support operational quality standards and departmental priorities
• Follow best practices and seek continuous improvement opportunities

Operational Leadership:

• Perform according to Human Capital frameworks and policies to meet standards and objectives
• Engage in development, coaching, and mentoring activities
• Support transformation efforts by valuing diversity
• Align behavior with Afrocentric values

Stakeholder Management:

• Maintain active, informative relationships with customers and stakeholders
• Handle complaints in line with policies, ensuring customer/stakeholder buy-in

Desired Experience & Qualification

• Registered Nurse with registration with the SA Nursing Council
• 1-2 years Managed Care Operations Experience
• 1-2 years Customer Service Experience
• 2-3 years General and Surgical Ward Experience
• 1-2 years Managed Health Care Experience (Call Centre) Advantageous
• 1-2 years Trauma / ER Experience Advantageous