Pre Auth Service Consultant - Inhouse

Discovery; Cape Town; On-site; ZAR 167,000 - 257,000; Full time

Job summary

Discovery Health is seeking a dedicated service professional to support Inhouse scheme stakeholders, resolving queries via calls and other channels. The role emphasizes clinical knowledge, accurate funding decisions, and maintaining high-quality customer service.

Applicants should have Matric, a SA-accredited clinical qualification, and at least 6 months of customer service or clinical experience, with adaptability to overtime and weekend training as required.

Qualifications

• Matric as minimum educational requirement.
• SA accredited clinical qualification required or HR equivalent.
• Minimum 6 months customer service or clinical experience.

Responsibilities

• Deliver world-class service to Inhouse scheme stakeholders via telephone and other channels.
• Accurately capture and verify information for correct funding and benefits.
• Resolve queries, escalate where necessary, and maintain CRM records.

Skills

Time Management

Verbal and written communication

MS Office & Outlook

Education

Matric

South African accredited Clinical Qualification

Tools

MS Office

Outlook

Job description

Key Purpose

To deliver world class service to all Inhouse scheme stakeholders (Members, Providers, Employer groups, Hospitals, and Brokers) by supporting and fully resolving their queries through various servicing channels, primarily over the telephone.

To effectively manage the risk of benefit authorisations (funding from risk) by using your clinical knowledge and integrating this with your understanding of the benefits of the scheme and ensuring accurate information regarding funding

Key outputs

• Confirming Inhouse scheme benefits according to set protocols and funding rules
• Accurately obtaining and capturing information to confirm correct Inhouse scheme funding
• Servicing all Inhouse scheme stakeholders telephonically and via other servicing channels until the query has been resolved
• Servicing Inhouse scheme
• stakeholders in a customer centric way to ensure that we live by our service principles
• Keeping up to date with product changes and benefits to ensure that all stakeholders are accurately serviced
• Continuously staying abreast of all digital servicing tools within the business and ensuring that the functionality is fully understood
• Achieving and exceeding key performance metrics relating to service delivery
• Keeping abreast of continuous process, product updates and digital tools
• Dealing with multiple interactions
• Consistently utilizing all servicing tools available
• Ensuring excellent quality service to all callers
• Identifying and reporting back on issues identified with systems
• Maintaining the brand as set out by the various schemes
• Routing all enquiries to correct departments, where applicable
• Assisting with CRM queries daily
• Must be willing to work overtime where necessary
• Attend additional training outside of working hours including weekends

Competencies and Skills

Behavioural Competencies

• Following instruction and procedures (Self-development)
• Analysing (Managing Complexity)
• Learning and Researching (Nimble Learning)
• Presenting and communicating information (Communicating effectively)
• Delivering results and meeting customer expectations (Customer focus)
• Deciding and initiating action (Decision Quality)
• Working with people (Collaborating)
• Writing and reporting (Communicating effectively)
• Clinical Knowledge
• Adapting and responding to change
• Persuading and influencing
• Adhering to principles and values
• Achieving personal work goals and setbacks
• Resolution driven

Knowledge

• Anatomy and Physiology

Skills

• Time Management
• Verbal and written communication
• Computer Literate with MS Office and Outlook skills

Personal Attribute and Skills

• Customer Centric
• Knowledge of Anatomy and Physiology
• Time Management
• Living Discovery Values
• Discovery person traits
• Empathetic
• Resilience

Education and Experience

Education

• Matric
• South African accredited Clinical Qualification- HR to provide minimum requirement

Experience

• At least 6 months working experience in a customer services or clinical environment

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.