Case Manager – Medical Aid – R25 to R31 000.00 CTC- Bryanston
New and exciting vacancy available at this forward thinking and dynamic medical aid organisation based in Bryanston. Seeking the services of an experienced and dedicated case manager. Good personal attributes would be well organised, hardworking, and an ability to absorb pressure. Excellent future career prospects and opportunity for growth both personally and professionally.

Scope of responsibility:
? Overall responsibility for incoming calls from Hospitals Case Managers relating to authorizations for procedures in Hospitals, Casualty, GP or Dental providers rooms.
? Hospital case management from the issuing a guarantee of payment (GOP) to final discharge and any follow up treatment where required.
? All medicines related issues for special cases and off formulary items
? Monitor hospital and provider abuse
? Ensure that all calls and cases are fully and clearly recorded on the MIP system accordingly.
? Ensure efficient Customer Service and compliance to agreed SLA’s
? Follow up with GP providers who may be over utilizing the “in rooms” procedures.
? Manage and maintain data integrity and update accordingly where necessary
? Ensure all enquiries are resolved satisfactorily and customer requirements within business rules and costing factors are maintained
? Regularly review all approved claims and ensure that all are settled according to correct tariffs and procedures
? Supply all monthly management reports
? Any other duties as assigned by your supervisor from time to time

Previous qualifications skills and experience:
? Matric
? Registered Nursing diploma
? Valid membership of SANC
? At a minimum of at least 3-4 years’ experience in a similar role
? MIP Application System experience would be an advantage.
? Sound understanding of the South African Health Industry, benefits and options etc.
? ICD codes, modifiers and RPL tariff knowledge and understanding
? Ability to liaise with external parties – clinicians and members
? Ability to work within an established team
? Excellent oral and written communication skills
? Customer centric attitude
? Excellent analytical skills and pays attention to detail
? Computer literate - MS Office suite, i.e. Word, Excel
? A good understanding of claims risk profiling
? Experience in claims auditing

Clear criminal record, ITC and contactable previous employment references are essential. Please mail a comprehensive CV