Pre Auth Service Consultant - Inhouse

Key Purpose

To deliver world class service to all Inhouse scheme stakeholders (Members, Providers, Employer groups, Hospitals, and Brokers) by supporting and fully resolving their queries through various servicing channels, primarily over the telephone.

To effectively manage the risk of benefit authorisations (funding from risk) by using your clinical knowledge and integrating this with your understanding of the benefits of the scheme and ensuring accurate information regarding funding

Key outputs

The successful applicant will be responsible for but not limited to the following job functions:

Confirming Inhouse scheme benefits according to set protocols and funding rules

Accurately obtaining and capturing information to confirm correct Inhouse scheme funding

Servicing all Inhouse scheme stakeholders telephonically and via other servicing channels until the query has been resolved

Servicing Inhouse scheme

stakeholders in a customer centric way to ensure that we live by our service principles

Keeping up to date with product changes and benefits to ensure that all stakeholders are accurately serviced

Continuously staying abreast of all digital servicing tools within the business and ensuring that the functionality is fully understood

Achieving and exceeding key performance metrics relating to service delivery

Keeping abreast of continuous process, product updates and digital tools

Dealing with multiple interactions

Consistently utilizing all servicing tools available

Ensuring excellent quality service to all callers

Identifying and reporting back on issues identified with systems

Maintaining the brand as set out by the various schemes

Routing all enquiries to correct departments, where applicable

Assisting with CRM queries daily

Must be willing to work overtime where necessary

Attend additional training outside of working hours including weekends

Competencies and Skills

Following instruction and procedures (Self-development)

Analysing (Managing Complexity)

Learning and Researching (Nimble Learning)

Presenting and communicating information (Communicating effectively)

Delivering results and meeting customer expectations (Customer focus)

Deciding and initiating action (Decision Quality)

Working with people (Collaborating)

Writing and reporting (Communicating effectively)

Clinical Knowledge

Adapting and responding to change

Persuading and influencing

Adhering to principles and values

Achieving personal work goals and setbacks

Resolution driven

Anatomy and Physiology

Time Management

Verbal and written communication

Computer Literate with MS Office and Outlook skills

Personal Attribute and Skills:

Customer Centric

Knowledge of Anatomy and Physiology

Time Management

Living Discovery Values

Discovery person traits

Empathetic

Resilience

Education and Experience

• Matric
• South African accredited Clinical Qualification- HR to provide minimum requirement
• At least 6 months working experience in a customer services or clinical environment