Hospital Benefit Specialist

About the role

The Hospital Benefit Specialist is part of Discovery Care’s Chronic and Prescribed Minimum Benefit (PMB) Management team, based in Richards Bay, KwaZulu‑Natal. The role is responsible for assessing hospital admission requests, ensuring members receive appropriate care while managing benefit risk for the scheme.

Key responsibilities

• Assess each case against clinical history, benefit structure, coding, level of care, facility, treating doctor and treatment appropriateness.
• Approve or decline funding decisions to ensure members receive the correct level of care.
• Plan discharges by offering alternatives such as Hospital @ Home or Homecare.
• Communicate effectively with providers, members, patient services managers and hospital staff.
• Provide case updates, funding confirmations and request additional information when needed.
• Handle escalations from providers and internal stakeholders.
• Prepare and present complex cases for clinical review.
• Conduct trend analysis of inefficiencies and propose corrective actions.
• Make internal referrals for clinical management and meet operational targets.
• Attend to daily patient reports and review low‑acuity admission requests.

Required profile

• Accountable and action‑oriented.
• Strong communication and customer‑focus skills.
• High decision quality and ability to manage complexity.
• Commitment to delivering quality processes.
• Ability to work collaboratively with multiple stakeholders.

Required skills