JOB DETAILS:
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)