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Hospital Benefit Specialist - Cape Town
Discovery LimitedCape Town, ZA10 days ago
Job descriptionThe successful applicant will be responsible for but not limited to the following job functions : Members clinical history Members benefit structure Clinical Information and coding supplied Level of care provided Appropriateness of the facility Appropriateness of the treating doctor Appropriateness of treatment Managing the benefit for the member and the risk for the relevant scheme through a thorough process to approve or decline Funding to ensure that the member gets the appropriate level of care Discharge planning by providing the member with alternatives to receive treatment (This includes Hospital @ Home, Homecare etc.) Case update to the provider Funding decisions and benefit confirmation to the members Request for additional information from the treating doctor or practice manager Engaging with Patient Services Manager and hospital staff Handling escalations from Providers and internal stakeholders Preparing and presenting complex case to clinical review Trend Analysis of inefficiencies and proposals to correct Appropriate internal case referrals for clinical management Attend to patients on daily report Review all low acuity admission requests Quality of processes Ensures accountability. Action oriented Manages ambiguity. Attracts top talent. Business insight Collaborates Communicates effectively. Manages complexity. Manages conflict. Courage Customer focus Decision quality Develops talent Values differences Directs work. Drives engagement Financial acumen Global perspective Cultivates innovation. Interpersonal savvy Builds networks. Nimble learning Organizational savvy Persuades Plans and aligns. Being resilient Resourcefulness Drives results Demonstrates self-awareness. Self-development Situational adaptability Balances stakeholders Strategic mindset Builds effective teams. Tech savvy Instils trust. Drives vision and purpose Optimizes work processes Matric Must be a Registered Nurse Valid SANC Registration 3 years Clinical experience in a private hospital setting (ICU, Trauma / Casualty, Medical / General ward preferable) 2 years Managed health care experience Microsoft Office (Specifically Excel experience) Valid Driver’s License and own transport ( working hours are between 08 : 30 -17 : 00 & travel up to 50KM may be required) Effective Communication Skills (Verbal & Written) Telephone Etiquette Active Listening Skills 1 – 2 years ICU experience Knowledge of DH SOP’s and Process experience (internal only) Provider payment arrangements (internal Only) Clinical coding knowledge of ICD-10 and / or CCSA Medical / Healthcare jobs
Job title : Hospital Benefit Specialist - Cape Town
Job Location : Western Cape, Cape Town Deadline : October 08, 2025 Quick Recommended Links
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Key Purpose :
Assessing the case in relation to the following :
Effective and accurate communication to all stakeholders :
Operational Targets :
Competencies :
The successful candidate must demonstrate the following competencies :
Role Specific Behaviours
Education and Experience :
The following requirements are essential :
The following requirements are advantageous :
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Specialist Cape Town • Cape Town, ZA