PMB Specialist (Psych) Temp

Discovery Care, a subsidiary of Discovery Health, comprises of several specialized clinical areas with segmented teams. The Chronic and PMB Management team handles the processing of Chronic and Prescribed Minimum Benefit requests and manages escalated clinical queries. The HIV/Oncology and In-Hospital Case Management teams review clinical cases specific to their areas of expertise.

The High Touch team provides hands-on services and resolves escalated queries for sensitive cases. Additionally, the Hospital Benefit Specialists, as part of field force, are responsible for real-time risk management and the Care Coordination Services manages the Managed Care programs.

The processing of out of hospital PMB Psychotherapy applications in line with PMB protocols and in accordance with the benefit entry criteria

To assist and support the PMB Operations team with ad hoc projects and tasks

The following requirements are essential:

Matric

Strong verbal and communication skills

Proficiency in MS Office Suite (Word, Excel, PowerPopint and Outlook)

Previous experience in Administration, Data Capturing or Call Centre environment

The following requirements are advantageous:

Prior experience within Discovery

Prior experience in a Medical Scheme or Medical Insurance environment

Indepth understanding of Discovery health product benefits, funding structure and policy rules

Working knowledge of Discovery knowledge

Basic Clinical knowledge

Reviewing a limited section of the PMB Psych application forms from members & providers and making appropriate funding decisions by applying PMB protocols.

Working towards daily outputs of production and quality to ensure member satisfaction.

Apply government stipulations in terms of PMB’s and treatment algorithms.

Communication with members and provider ssurrounding PMB decision outcomes.

Adhoc duties within the PMB Psych team may be required.