Key Purpose:
- To accurately review and assess In Hospital related queries and updates, in line with Discovery Health products and in accordance with benefit entry criteria and established protocols
Key Outputs:
The successful applicant will be responsible for but not limited to the following job functions:
- Dealing with all IH queries and escalations through to resolution
- Enforcing policy, protocol and benefits decisions
- Meeting daily Operational Targets, TWT, etc.
- Ad Hoc duties based on business requirements
- Communicating effectively and accurately, progress, outcomes to complainants verbally and in writing
- To liaise with relevant stakeholders involved in the member’s care to ensure the best possible member journey.
Skills:
- Adapts interpersonal style to suit different people or situations
- Adapts to changing circumstances
- Assertive and confident
- Attention to detail
- Customer focused
- Demonstrates integrity
- Shows urgency and passion for servicing
Competencies:
The successful candidate must demonstrate the following competencies:
Role Specific Behaviours
- Ensures accountability.
- Action oriented
- Manages ambiguity.
- Attracts top talent.
- Business insight
- Collaborates
- Communicates effectively.
- Manages complexity.
- Manages conflict.
- Courage
- Customer focus
- Decision quality
- Develops talent
- Values differences
- Directs work.
- Drives engagement
- Financial acumen
- Global perspective
- Cultivates innovation.
- Interpersonal savvy
- Builds networks.
- Nimble learning
- Organizational savvy
- Persuades
- Plans and aligns.
- Being resilient
- Resourcefulness
- Drives results
- Demonstrates self-awareness.
- Self-development
- Situational adaptability
- Balances stakeholders
- Strategic mindset
- Builds effective teams.
- Tech savvy
- Instils trust.
- Drives vision and purpose
- Optimizes work processes
Education and Experience:
The following requirements are essential:
- Matric
- Nursing Qualification (Enrolled/Professional Nurse)
- Valid SANC Registration
- Discovery Health working experience in a clinical role
- Discovery Health products and system knowledge
- PMB Legislation Knowledge
- Analytical Skills
- Effective Communication Skills (Written & Verbal)
- MS Office
The following requirements are advantageous:
- 1 year CRM Experience
- Discovery Health Pre-Authorizations working experience
Personal Attributes or Competency Profile
The Discovery Person
- Values Driven
- Optimistic
- Learns on the Fly
- Resilient
- Instils Trust
- People Savvy
- Drives Results
- Problem Solver