- Educated to degree level or equivalent experience in similar field / role
- Post-graduate level or equivalent experience
- Knowledge of medical/dental law and ethics, and regulatory environment, policies and procedures
- Legal or medical /dental qualification
- Customer service / member management
- Management of claims / cases of varying complexity
- Experience in healthcare or legal background
- Experience of training, coaching or mentoring
- Regulatory / Inquests /Criminal Case management
- Working with medics / dentists or other professional bodies
- Bonus (up to 15%)
- Pension
- Medical Aid
- Group Life Cover
-
Case Manager
5 days ago
Careforce Recruitment Gauteng, South AfricaOur client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organization with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. · Position: Case Manager (Member Ma ...
-
Case Manager
1 week ago
iMedrecruit Pretoria, South AfricaAbout the job Case Manager (Member Management) 12 Month FTC - Pretoria · **Case Manager (Member Management) 12 Month FTC - Pretoria** · Our client, focusing on a risk and clinical assessment offering, is requiring a Case Manager (Member Management). · **Requirements (but not limi ...
-
Case Manager
5 days ago
care force Pretoria, South AfricaOur client, a managed care organisation based in Pretoria is looking for a Case Manager. This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries. · Position: Case Manager (Member Ma ...
-
Case Manager
1 week ago
Medical Protection Society Pretoria, South AfricaJob Introduction · Main Responsibilities · Responsibilities will include but not limited to the following · **Service Delivery** · Deliver the performance of assigned case files in accordance with governance, policy and process ensuring quality and fair outcomes for the member an ...
-
Case Manager
1 week ago
Careforce Recruitment Pretoria, South AfricaPosition: Case Manager (Member Management) · Reporting to: Senior Specialist Clinical Management · Location: On-site at the Head Office, Pretoria · **Qualifications**: · - Enrolled/ Registered Nurse · - Valid registration with SANC · **Skills and Competencies Required**: · - 3 to ...
-
Case Manager
1 week ago
HRInsync Pretoria, South Africa**Case Manager** · **About** · One of the largest private Medical Aid companies in SA. They have been established for 20 years and are striving to be #1 in SA. · **Purpose** · Delivering of cost-effective managed healthcare service to accomplish member satisfaction · **Duties and ...
-
Case Manager
1 week ago
iMedrecruit Pretoria, South Africa**Case Manager (Member Management) 12 Month FTC - Pretoria** · Our client, focusing on a risk and clinical assessment offering, is requiring a Case Manager (Member Management). · **Requirements (but not limited to)** · - Perform Clinical coding in accordance with CPT and ICD requ ...
-
Case Manager
1 week ago
Medical Protection Society Pretoria, South Africa**Job Introduction**: · **Role Responsibility**: · Responsibilities will include but not limited to the following · **Service Delivery** · Deliver the performance of assigned case files in accordance with governance, policy and process ensuring quality and fair outcomes for the m ...
-
Case Manager
4 days ago
Medical Protection Society Pretoria, South AfricaJob Introduction · The Member Cases and Claims Division is at the forefront of protecting the careers, reputation and financial risk of our members worldwide. The purpose of the role is to support the provision of excellent case handling services for members which is trusted and ...
-
Case Manager
5 days ago
H2R Pretoria, South AfricaGauteng, Tshwane (Pretoria) · - Monthly Cost To Company (Market related, Negotiable) · Our client, who is in the Health Care Industry, has a vacancy for a Case Manager on a Contract Basis, with a possibility of it becoming permanent · The Case Manager will have thorough, well-gro ...
-
Case Manager
14 hours ago
Medley Recruitment Pretoria, South AfricaThe key responsibility will be liaison between the patients and medical aid companies, ensure that correct coding (ICD & CPT) is used, authority received for LOS and monitoring of patients costs to ensure the hospital receive payment for services rendered. · **Requirements**: · G ...
-
Case Manager
14 hours ago
TB HIV Care Pretoria, South Africa**Job Advert Summary**: · **Purpose of Position** · To conduct follow-up and/or psychosocial activities in the PWID community by providing current accurate health information and linkage to care. Provide health care counselling, and guide for testing services in non-clinical site ...
-
Hbm Case Manager
1 week ago
Medpharm Recruitment Pretoria, South AfricaA reputable Medical Aid based in Pretoria is seeking a Case Manager to join their HBM team. · **Job purpose**: · - Delivering a cost-effective Managed Healthcare service to accomplish member satisfaction. · **Qualification / Experience**: · - Grade 12 / Matric · - B Cur Degree or ...
-
Medical Case Manager
1 week ago
Africa and Worldwide Medical Assistance Company (PTY) Ltd Gauteng, South AfricaDuties may however include but not be limited to assistance relating to: · - Emergency Medical Services · - GP Authorizations · - Hospital Pre-Authorization and claims · - International Travel Assistance · - Trauma Counselling · - Medical Advice · - Invoice Management · - Basic A ...
-
Pre-litigation Case Manager
2 days ago
AristoSourcing Inc. Pretoria, South AfricaAristoSourcing LLC is an Outsourcing company highly focused on the Digital Marketing Industry. Our company has been in the industry for more than 7 years. We hired and referred skilled and experienced Virtual Assistants to work and collaborate directly with our respective clients ...
-
Drm Case Manager Sabmas
1 day ago
3SixtyHealth (Pty) Ltd Gauteng, South Africa**POSITIONS ** Disease Risk Case Manager · **DIVISION ** Operations · **DEPARTMENT ** Managed Health Care · Proper risk management and integration of preventative healthcare services with the objective of promoting self-management and better control of chronic conditions through ...
-
Eap Case Manager
2 days ago
Health Solutions Centurion, South Africa**Introduction** · Momentum Health Solutions (MHS), an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health and wellness solutions that meet the needs of clients in the different segments and maximize lifetime client value. We build and maintain a cult ...
-
Case Manager
1 week ago
Tax Consulting South Africa Bryanston, South AfricaOne of the foremost, Immigration Consulting firms have an exciting opportunity for an enthusiastic Case Managers, to join their dynamic team. This permanent position is well suited to an individual who will dedicate time and effort to grow themselves professionally and become a k ...
-
Case Manager
5 days ago
STARTEK Sunninghill, South AfricaOur company is looking to fill the role of a Case Management Agent, with automotive experience, to be based at our offices in Sunninghill. · Skills required: · - Grade 12 or equivalent · - Post matric qualification in the call centre industry, advantageous · - A minimum of 2 year ...
-
Case Manager
1 week ago
Watershed Consulting Sandton, South Africa**Job Description**: · We are looking for a **Case Manager** who is a _Registered Nurse_ with a valid _SANC Membership_ and ideally has some experience in the healthcare insurance space. You will be handling incoming calls from Hospitals Case Managers relating to authorizations f ...
Case Manager - Pretoria, South Africa - Medical Protection Society
Description
Job Introduction
The Member Cases and Claims Division is at the forefront of protecting the careers, reputation and financial risk of our members worldwide. The purpose of the role is to support the provision of excellent case handling services for members which is trusted and valued and provides fair treatment and outcomes. The role will do this by managing a case load of files and using expert knowledge and judgement to formulate strategies in order to advise and guide members on relevant processes, ensuring an excellent member service is provided
Role Responsibility
Responsibilities will include but not limited to the following
Service Delivery
Deliver the performance of assigned case files in accordance with governance, policy and process ensuring quality and fair outcomes for the member and the membership fund
Proactively manage assigned case files and work effectively to deliver within agreed SLAs ensuring maximum efficiency is achieved whilst providing an excellent service to the member.
Escalate as required any technical matters and/or for advice using such opportunities to build confidence and competence in role
Support Case Handling projects/initiatives ensuring delivery of projects to time, cost and quality and that can demonstrate a return on investment
Financial
Manage all spend incurred serving members in accordance with MPS organisation governance and policy
Minimise case costs through proactively managing estimates, challenging costs and invoices from all third party
Determine the level of member assistance to be granted in accordance with the membership policy and benefits on individual cases; escalate cases where out of policy discretion requires consideration.
Member
Manage informal complaints / expressions of dissatisfaction to achieve first touch resolution for our members and in accordance with policy standards and process ensuring fair outcomes for members, the membership fund
Seek opportunities to continuously improve ways of working and contribute to team, department and divisional continuous improvement projects aimed to drive operational efficiency and great member experiences and outcomes
Deliver at all times fair treatment and outcomes for members and compliance with associated policies and standards set out by Council, its committees and delegated authorities
Using the most appropriate channel of communications, keep members regularly informed ensuring the advice and support reflects policy, relevant codes of practice, is technically accurate and with outcomes delivered in a professional and empathetic manner
The Ideal Candidate
Essential
Desirable
Essential Experience
Desirable Experience
Package Description
Benefits will include;