CHRONIC BENEFIT CONSULTANT

Advert Ref: RMQ732

Advert Title: Chronic Benefit Consultant

Area: La Lucia, Durban

Advert Type: Full-Time

Working Hours: 40 Hours

Time Conditions: Dayshift

Salary: R15,000 – R32,000

Closing Date: 22 October 2022


Role Purpose

The successful candidate will be required to manage the registration request for Chronic conditions/ treatment, chronic related queries and to give support to the Health Risk Management team. This position will report to the Medicine Risk Manager and is based in Umhlanga.


Requirements

  • Matric

  • Post Basic Pharmacist assistant qualification is essential

  • Previous Health Risk Management experience would be an advantage

  • Previous experience in a managed care environment dealing with Health Risk Management would be an advantage

  • Registration with the Pharmacy Council as Pharmacist Assistant would be an advantage

  • Clinical Knowledge

  • Computer literate

  • Good telephone etiquette


Duties & Responsibilities

  • All interactions, telephonic and written, with members, providers, brokers and internal stakeholders to be professional

  • Registration of medicine and/or diagnosis to be done timeously and independently in accordance to La Lucia Hospital Health policies and scheme formularies

  • Develop effective relationships and ensure that Service Level Agreements with External clients and internal departments are maintained thus ensuring excellent service to the scheme, members, providers as well as internally

  • 24 hour turnaround –; Maintain a consistent and quality 24 hour turnaround time from receipt of documents/calls into the Medicine Risk Management department

  • Provide 1st time and timeous resolution on queries

  • Provide effective management of a patients disease and lifestyle to promote an integrated and holistic approach to managing the healthcare of a member

  • To provide support and assistance to the DUR Pharmacist, DRM, HRM and Clinical Governance departments in terms of medical management and clinical input.

  • Ensure effective claims management service delivery and support

  • Perform an efficient and accurate administrative function to the team.

  • Identify all compliance risks and bring to the attention of the team leader for review.

  • Monitor customer delivery constraints and escalate to management

  • Identify and investigate all possible non-disclosure of pre-existing conditions

  • Identify the appropriate entry criteria and ensure consistent and correct authorizations in line with clinical policies and the relevant scheme rules and formularies

  • Have the capacity to develop oneself and others via the various training options thus positively growing oneself and the team.


Competencies

  • Customer focused

  • Excellent verbal and written Communications Skills

  • Good interpersonal skills

  • Attention to detail

  • Service oriented

  • Stress tolerant and working under pressure

  • Empathetic

  • Proactive

  • Highly motivated

  • Drive and support effective teamwork within the Department


Interested Applicants who meet the requirements may apply here on our website or use the email address of La Lucia Hospital HR Manager STELLA VAN ROOY [stellavanrooy@laluciahospital.com]. Applicants will be conducted shortly, Should you not be contacted in 14 days of your application, Please consider your application unsuccessful and thank you for your interest in our healthcare group.