Hospital Benefit Specialist

About the role

The Hospital Benefit Specialist supports Discovery Care’s field force in Durban by managing real‑time risk and benefit decisions for hospital admissions. The role ensures members receive appropriate care while protecting scheme finances through thorough case assessment and coordinated discharge planning.

Key responsibilities

• Assess each case against the member’s clinical history, benefit structure, coding, level of care, treating doctor and facility suitability.
• Approve or decline funding decisions to align with benefit rules and risk management objectives.
• Provide discharge planning options such as Hospital @ Home or Homecare.
• Communicate updates, funding decisions and benefit confirmations to providers, members and internal stakeholders.
• Request additional clinical information from treating doctors or practice managers as needed.
• Handle escalations from providers and internal teams, and present complex cases for clinical review.
• Analyse trends in case processing, identify inefficiencies and propose corrective actions.
• Meet operational targets, review low‑acuity admission requests and ensure quality of processes.

Required profile

• Accountable and action‑oriented with a strong customer focus.
• Effective communicator who can engage with providers, patient services managers and internal teams.
• Decision‑quality driven and able to manage ambiguity in clinical benefit rules.
• Detail‑oriented with the ability to conduct trend analysis and present findings.
• Based in Durban and able to work onsite as part of the field force.

Required skills

• Clinical coding.
• Trend analysis of case data.