ROLE SUMMARY
We are seeking a professional and experienced Medical Case Manager to join our team.
The purpose of this role is to provide medical expertise and to contribute towards the successful delivery of the Company’s service output. The employee will do this by performing tasks and assuming responsibilities which may include hospital pre-authorization and claims, international patient case management and medical repatriations, providing medical advice and counseling services.
If you are passionate about healthcare, possess strong administrative and communication skills, and thrive in a dynamic and collaborative environment, we encourage you to apply for this exciting opportunity.
Must be able to work shifts (day and night).
QUALIFICATIONS
- Minimum: Grade 12 or equivalent NQF level 4
- Minimum: Basic Life Support accreditation / equivalent
EXPERIENCE
- Minimum of 2 years’ working experience in a similar position
- Call center experience will be an advantage
- Medical and Insurance background will be an advantage
SKILLS & KNOWLEDGE
- Strong clinical background
- Excellent telephonic and written communication skills
- Multilingual
- Proficiency in Microsoft Office suite
- Knowledge of local medical aid and medical insurance and international patient case management principles and healthcare management
- Short-Term Insurance principles and workings
RESPONSIBILITIES
- Provide compassionate, caring and friendly care and guidance to clients.
- Coordinate emergency medical services including arranging triage and dispatch ambulances.
- Coordinate GP, emergency room and hospital pre-authorization.
- Facilitate health advisory services according to prescribed protocols.
- Facilitate counselling services according to prescribed protocols including obtaining and capturing client details, registering a case, allocation to a counsellor, and following up on the outcomes.
- Coordinate international case management, medical repatriations and the repatriation of mortal remains.
- Adjudicate cases as per product benefits, limits and conditions.
- Maintain detailed and accurate records of client interactions, appointments, and treatment outcomes.
- Facilitate the repatriation of mortal remains by obtaining and capturing client details, verifying insurance cover, coordinating the logistics to move remains with the service provider and update all stakeholders.
- Answer calls as and when required and perform any other administrative tasks or ad hoc duties
COMPETENCIES
- Showing Composure: Remains calm and does not get anxious before or during important events. Works well under pressure.
- Examining Information: Analyses and processes information very effectively when solving problems. Very curios and good at asking probing questions.
- Conveying Self Confidence: Self-confident and positive about themselves. Strong sense of own worth and feels in control of their future.
- Documenting Facts: Communicates well in writing, readily understand the logic behind an argument and will ensure that all the relevant facts are taken into consideration.
- Checking Things: Very thorough and even perfectionistic, ensures that things are done properly, delivering high quality work with great attention to detail.
- Producing Output: Works at a fast pace, works well when busy and copes well with multi-tasking.
- Managing Tasks: Very effective at planning and organizing, identifies clear priorities and milestones.
- Articulating Information: Is articulate in giving presentations; is eloquent and explains things well; projects social confidence when articulating information.
- Following Procedures: Extremely rule following, procedural and risk averse.
- Understanding People: Good at listening and understanding how others are feeling and why people behave as they do. Is attentive and understands what motivate others.