HBM Pre-Authorization Consultant

About the role

Join Bestmed Medical Scheme as an HBM Pre-Authorization Consultant, providing clinical expertise to manage authorisations and ensure cost-effective healthcare delivery for scheme members. You will work in a fast-paced call-centre environment, supporting members and healthcare providers while maintaining high service standards.

Key responsibilities

• Process new pre-authorisations daily, meeting target volumes and quality standards.
• Handle inbound calls, manage case queues, and resolve pended cases within agreed service level agreements.
• Conduct risk-management activities to minimise hospital and authorisation risks.
• Negotiate discounts and monitor annual cost-saving targets.
• Maintain attendance and performance metrics as defined in the service contract.
• Participate in ongoing training to stay current with scheme protocols and clinical guidelines.
• Deliver effective customer service, ensuring average answering time and abandoned-call rates remain within SLA.
• Monitor cost per admission and benefit expenditure to keep expenses below budgeted limits.

Required profile

• Grade 12 qualification and enrolment in a nursing programme.
• Minimum five years’ experience as a nursing practitioner in ICU, trauma, theatre or other specialised wards.
• Active registration with the South African Nursing Council (SANC).

Required skills

• Clinical assessment and decision-making.
• Knowledge of pre-authorization processes and medical scheme protocols.

What we offer

• Opportunity to make a tangible impact on member health outcomes.
• Professional development and continuous training.
• Collaborative team environment focused on excellence in healthcare delivery.