Role Purpose
To ensure best practice is followed in providing medical care and treatment.
Requirements
- Matric.
- Registered Nurse is essential.
- 2-3 years’ experience within the managed care industry.
- Excellent understanding of the scheme products and legislation.
- Effective management of scheme rules in line with clinical guidelines.
- Knowledge of PMB guidelines.
- Telephonic etiquette.
Duties and Responsibilities
- Attain daily KPI of 70 – meet the prescribed number of calls (240 seconds Handling time per call).
- Maintain quality customer service.
- Bin management turn-around time of 48 hours.
- Implementation of policies/protocols related to scheme benefits.
- Benefits in and out of hospital are appropriately controlled.
- Exclusions are correctly and consistently applied.
- Positive relationships are built and maintained with hospitals and providers.
- Appropriate referral to case management team.
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