Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.

Job Description

To manage medical benefit utilization through supervision of pre-authorization answer queries over the phone and give timely solutions to the customer.

• Pre-Authorization of all admissions within 6 hours and technical guidelines.
• Minimize identifiable cases of fraud/abuse
• To resolve customer queries over the phone and offer solutions to the customers in a timely manner
• Supervise Pre-authorization of scheduled and non-scheduled admissions within the set guidelines and carry out verification and medical Audit of claims/invoices before settlement.
• Managing requests for services from providers, intermediaries and clients, providing information on the UAP Old Mutual provider network and available benefits per scheme policy
• In conjunction with SMART applications resolve card issues raised at the point of service
• Authorization of all optical requests from the different providers within 6 hours and prepare daily reports
• To attend to reimbursements from the different providers in a timely manner and provide daily reports.
• Liaise with other medical schemes for purposes of evaluating medical risk.
• To formulate committal letters of discharges as a result of the requests from the different service providers.

Skills

Authentication, Call Center, Customer Queries, Daily Reporting, Data Query, Invoices, People Management, Point of Service, Reimbursement, School Admissions, Supervision

Education

Diploma (Dip): Nursing (Required)