Pre-Authorization Consultant (Talent Pool)

About the role

The Pre‑Authorization Consultant ensures that best practice is followed when providing medical care and treatment. Working within a managed‑care environment, the role focuses on applying scheme rules, clinical guidelines and legislation to authorise benefits efficiently.

Key responsibilities

• Achieve a daily KPI of 70 calls with an average handling time of 240 seconds.
• Maintain high‑quality customer service and meet a bin‑management turnaround time of 48 hours.
• Implement policies and protocols related to scheme benefits, controlling in‑ and out‑of‑hospital benefits.
• Apply exclusions consistently and refer complex cases to the case‑management team.
• Build and maintain positive relationships with hospitals and service providers.

Required profile

• Matric qualification; registered or enrolled nursing qualification is advantageous.
• 2‑3 years of experience in the managed‑care industry.
• Strong understanding of scheme products, legislation and clinical guidelines.
• Excellent telephonic etiquette and communication skills.

Required skills

• Knowledge of PMB (Prescribed Minimum Benefits) guidelines.
• Telephonic etiquette.