Pre-Auth Non Clinical Consultant at Momentum Metropolitan Holdings Limited

Role Purpose    

• Deliver professional service to clients through various servicing channels (inbound calls, emails, walkin interactions etc.), responding to their needs, concerns and complaints within agreed Service Level Agreements and legislative and compliance requirements.

Requirements    

• Matric with Biology
• 2-3 years’ experience within the managed care industry.

Duties & Responsibilities    

• Attain daily KPI of 70 – meet the prescribed number of calls (240 seconds Handling time per call).
• Maintain quality customer service.
• Bin management turn- around time of 48 hours.
• Implementation of policies/protocols related to scheme benefits.
• Benefits in and out of hospital is appropriately controlled.
• Exclusions are correctly and consistently applied.
• Positive relationships are built and maintained with hospitals and providers.
• Appropriate referral to case management team. 
• Appropriate referrals to case managers and Med/Advisor
• Bin management turn around 24 hours.
• Positive relationships are built and maintained with hospital providers and members.  

Competencies    
Understand how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group.

• Anticipate, meets, and exceeds client's needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
• Drive a sense of urgency, focus, accountability, agility, and execution to deliver business results.
• Actively leads change, does what is right for the business and drives continuous improvement through innovation.
• Prioritise the business interests of MMH and invests in the success of the group by aligning effort across divisions.
• Persuade, convinces, influences, and inspires others, both within MMH and externally to win support, loyalty, and gain commitment to the purpose of MMH.
• Manage self and relationships with others effectively, deals with ambiguity, uncertainty, and pressure, and provides perspective in difficult situations.
• Sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.

Closing Date    
2023/03/10