Hospital Benefit Specialist

Discovery LimitedZA

12 days ago

Job description

Job title : Hospital Benefit Specialist

Job Location : Gauteng,

Deadline : November 30, 2025

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Key Purpose :

The successful applicant will be responsible for but not limited to the following job functions :

Assessing the case in relation to the following :

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.)

Effective and accurate communication to all stakeholders :

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

Operational Targets :

Attend to patients on daily report

Review all low acuity admission requests

Quality of processes

Education and Experience :

The following requirements are essential :

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

The following requirements are advantageous :

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

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Hospital Specialist • ZA

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