Case Management Specialist at Coloplast

Case Management Specialist

The Case Management Specialist is responsible for ensuring end-to-end case management for each of our consumers which includes applying for funding on behalf of consumers, following up with medical funders, answering consumer queries and escalating queries within medical schemes.

The ideal candidate will be a professional individual who learns quickly, has a keen eye for detail, has the aptitude to fully understand our end-to-end process and deliver exceptional case management while adhering to policies and processes.

You will be part of the Coloplast South Africa Team and report to the Case Management Lead.

Your key responsibilities will be

• Submission of relevant documentation to medical funders for authorisations

• Own and create the relationship with Medical Aid Schemes

• Collection of relevant documentation from consumers and/or their healthcare practitioners

• Following-up on cases out of scheme turnaround time

• Review funding outcomes on a case-by-case basis, within the bounds of protocols and escalate those that are insufficient.

• Monitoring and gaining an understanding of the evolution of medical aid plans

• Explaining funding outcomes to consumers as they are received and in accordance with SOP

• Logging consumer complaints in the CRM system timeously and following up with the necessary action

• Ensuring all case management interactions are recorded in the CRM system as per SOP

• Ensuring completeness and accuracy of case management tasks

• Responsible for case management outcomes and the investigation of any incomplete cases

• Answering of inbound case management related telephone calls

• Timeous resolution of queries (telephonic, email and CRM) within 2 business days

• Any other case management-related ad-hoc tasks

Professional qualifications

• At least two years of working experience

• Tertiary qualification is an advantage

• Previous experience in a medical field is an advantage

• Previous case management or medical aid experience is preferable

• ICD 10 coding knowledge is highly advantageous