Hospital Benefits Pre-Auth Consultant | 8-Hour Day

Bestmed Medical Scheme; Gauteng; Presencial; ZAR 420.000 - 540.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

23 days annual leave

8-hour workday with 30 min lunch

Life cover, disability, funeral cover,

Medical aid access

Training and development opportunities

On-site gym and wellness programme

Descripción de la vacante

Bestmed Medical Scheme in Gauteng is seeking a HBM Pre-Authorisation Consultant within the Hospital Benefit Management Department. The role focuses on delivering cost-effective managed healthcare and ensuring member satisfaction through accurate pre-authorisation decisions.

The ideal candidate will have Grade 12, enrolled nursing qualification, and at least 5 years of nursing practice experience in ICU, trauma, theatre, or specialised wards, with active SANC membership.

Formación

• Must have Grade 12 and enrolled nursing qualifications.
• Active SANC membership is mandatory.
• Minimum 5 years’ experience as a nursing practitioner in ICU, trauma, theatre or specialised ward.

Responsabilidades

• Act as the link between service providers, members and funding rules.
• Evaluate and approve/decline hospital funding requests before procedures.
• Verify member eligibility and coverage under plan type.
• Review limits, apply scheme rules, and manage exclusions and co-pays.
• Validate clinical codes (ICD, CPT, SAMA) and review doctor notes.
• Escalate complex cases and issue authorisation numbers as needed.
• Handle high volume calls and emails; communicate potential shortfalls or exclusions.
• Maintain confidentiality and comply with POPIA and SLAs.

Educación

Grade 12

Enrolled Nursing

Active SANC Membership

Descripción del empleo

Bestmed Medical Scheme in Gauteng is seeking a HBM Pre-Authorisation Consultant within the Hospital Benefit Management Department. The role focuses on delivering cost-effective managed healthcare and ensuring member satisfaction through accurate pre-authorisation decisions.

The ideal candidate will have Grade 12, enrolled nursing qualification, and at least 5 years of nursing practice experience in ICU, trauma, theatre, or specialised wards, with active SANC membership.