Hospital Benefit Specialist

Discovery Limited; Cape Town; On-site; ZAR 380,000 - 560,000; Full time

Job summary

Discovery Health in Cape Town is seeking a Hospital Benefit Specialist to assess members' clinical history, determine appropriate levels of care, and manage benefits within the Chronic and PMB management framework.

The role requires coordinating discharge planning, communicating decisions to providers and patients, and handling escalations while contributing to trend analyses and process improvements within Discovery Care.

Qualifications

• Must be a Registered Nurse with valid SANC registration.
• Minimum 3 years clinical experience in a private hospital setting (ICU, trauma/casualty, medical/general ward preferred).
• 2 years managed health care experience.
• Microsoft Office, specifically Excel experience.

Responsibilities

• Assess cases based on clinical history, coding, level of care and facility appropriateness.
• Communicate funding decisions and information to providers and members.
• Coordinate discharge planning and alternatives to hospital care.
• Engage with hospital staff, Patient Services Manager and providers for escalations.
• Provide trend analysis and propose improvements to care processes.

Skills

Excel

Education

Registered Nurse

SANC Registration

Matric

Tools

MS Office

Job description

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Business Unit: Discovery Health

Function: Clinical

Date: 3 Oct 2026

Hospital Benefit Specialist - Cape Town | Talent Pool

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.

Key Purpose:

The successful applicant will be responsible for but not limited to the following job functions:

Assessing the case in relation to the following:

• Members clinical history
• Clinical Information and coding supplied
• Level of care provided
• Appropriateness of the facility
• Appropriateness of the treating doctor
• Appropriateness of treatment
• Managing the benefit for the member and the risk for the relevant scheme through a thorough process to approve or decline Funding to ensure that the member gets the appropriate level of care
• Discharge planning by providing the member with alternatives to receive treatment (This includes Hospital @ Home, Homecare etc.)

Effective and accurate communication to all stakeholders:

• Case update to the provider
• Funding decisions and benefit confirmation to the members
• Request for additional information from the treating doctor or practice manager
• Engaging with Patient Services Manager and hospital staff
• Handling escalations from Providers and internal stakeholders
• Preparing and presenting complex case to clinical review
• Trend Analysis of inefficiencies and proposals to correct
• Appropriate internal case referrals for clinical management

Operational Targets:

• Attend to patients on daily report
• Review all low acuity admission requests
• Quality of processes

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

• Action oriented
• Attracts top talent.
• Business insight
• Manages complexity.
• Manages conflict.
• Courage
• Directs work.
• Global perspective
• Cultivates innovation.
• Interpersonal savvy
• Builds networks.
• Nimble learning
• Organizational savvy
• Plans and aligns.
• Demonstrates self-awareness.
• Self-development
• Situational adaptability
• Balances stakeholders
• Strategic mindset
• Tech savvy
• Instils trust.
• Drives vision and purpose
• Optimizes work processes

Education and Experience

The following requirements are essential:

• Matric
• Must be a Registered Nurse
• Valid SANC Registration
• 3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable)
• 2 years Managed health care experience
• Microsoft Office (Specifically Excel experience)
• Valid Driver’s License and own transport ( working hours are between 08:30 -17:00 & travel up to 50KM may be required)

The following requirements are advantageous:

• 1 – 2 years ICU experience
• Knowledge of DH SOP’s and Process experience (internal only)
• Provider payment arrangements (internal Only)
• Clinical coding knowledge of ICD-10 and/or CCSA

Personal Attributes or Competency Profile

The Discovery Person

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

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.