Job Objectives:

•     To resolve medical aid rejection queries with member where medical aid has no impact e.g. benefit exceeded
•     To resolve medical aid rejection queries with medical scheme e.g. medication authorization
•     To provide member with status update regarding rejection and resolution thereof.
•    To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical       aid three days prior to due date of delivery
•     To resolve queries received from patients within a two hour turn-around time e.g. extended supplies due to     member going oversees

Knowledge:

•    IT applications areas and delivery channels (Unisolv and Marconi )
•    Current IT technology (6 months)
•    Medical Aid Formularies (6 months)
•    Product knowledge (1 year)
•    Pharmacy Council Legislation (1 year)

Skills:

•    Communication skills   
•    Problem solving skills

Competencies:

Essential:

•     Analysing
•     Deciding and Initiating Action
•     Adhering to Principles and Values
•     Persuading and Influencing
•     Working with People
•     Adapting and Responding to Change
•     Achieving Personal Work Goals and Objectives
•     Applying Expertise and Technology
•     Following Instructions and Procedures
•     Delivering Results and Meeting Customer Expectations

Experience:

• One year within secretarial /admin position
• Business Process experience