Hospital Benefit Specialist

About the role

The Hospital Benefit Specialist supports Discovery Care’s Chronic and PMB Management team by reviewing hospital benefit requests, ensuring members receive appropriate care while managing risk for the scheme. Based in Empangeni, the role combines clinical assessment, funding decisions, and stakeholder communication in a fast‑paced environment.

Key responsibilities

• Assess each case against member clinical history, benefit structure, coding, level of care, facility, treating doctor and treatment appropriateness.
• Approve or decline funding to ensure members receive the correct level of care and manage discharge planning, including Hospital @ Home and Homecare options.
• Communicate decisions and updates to providers, members, and internal stakeholders; request additional information when needed.
• Engage with Patient Services Managers, hospital staff and handle escalations from providers and internal teams.
• Prepare and present complex cases for clinical review and conduct trend analysis to identify inefficiencies and propose corrective actions.
• Meet operational targets, review low‑acuity admission requests and ensure quality of processes.

Required profile

• Demonstrated accountability and action‑orientation.
• Strong communication skills and customer focus.
• High decision quality and ability to manage complexity.
• Experience in clinical case assessment, benefit management and risk mitigation.
• Ability to work collaboratively with multidisciplinary teams and handle escalations effectively.

Required skills