Hospital Benefit Specialist – Cape Town at Discovery Limited

September 8, 2025, 1:01 PM

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• Members clinical history

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• Members benefit structure

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• Clinical Information and coding supplied

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• Level of care provided

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• Appropriateness of the facility

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• Appropriateness of the treating doctor

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• Appropriateness of treatment

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• Managing the benefit for the member and the risk for the relevant scheme through a thorough process to approve or decline Funding to ensure that the member gets the appropriate level of care

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• Discharge planning by providing the member with alternatives to receive treatment (This includes Hospital @ Home, Homecare etc.)

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Effective and accurate communication to all stakeholders:

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• Case update to the provider

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• Funding decisions and benefit confirmation to the members

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• Request for additional information from the treating doctor or practice manager

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• Engaging with Patient Services Manager and hospital staff

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• Handling escalations from Providers and internal stakeholders

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• Preparing and presenting complex case to clinical review

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• Trend Analysis of inefficiencies and proposals to correct

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• Appropriate internal case referrals for clinical management

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Operational Targets:

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• Attend to patients on daily report

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• Review all low acuity admission requests

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• Quality of processes

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Competencies:

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The successful candidate must demonstrate the following competencies:

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Role Specific Behaviours

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• Ensures accountability.

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• Action oriented

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• Manages ambiguity.

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• Attracts top talent.

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• Business insight

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• Collaborates

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• Communicates effectively.

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• Manages complexity.

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• Manages conflict.

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• Courage

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• Customer focus

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• Decision quality

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• Develops talent

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• Values differences

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• Directs work.

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• Drives engagement

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• Financial acumen

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• Global perspective

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• Cultivates innovation.

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• Interpersonal savvy

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• Builds networks.

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• Nimble learning

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• Organizational savvy

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• Persuades

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• Plans and aligns.

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• Being resilient

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• Resourcefulness

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• Drives results

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• Demonstrates self-awareness.

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• Self-development

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• Situational adaptability

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• Balances stakeholders

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• Strategic mindset

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• Builds effective teams.

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• Tech savvy

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• Instils trust.

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• Drives vision and purpose

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• Optimizes work processes

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Education and Experience:

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The following requirements are essential:

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• Matric

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• Must be a Registered Nurse

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• Valid SANC Registration

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• 3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable)

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• 2 years Managed health care experience 

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• Microsoft Office (Specifically Excel experience)

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• Valid Driver’s License and own transport ( working hours are between 08:30 -17:00 & travel up to 50KM may be required)

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• Effective Communication Skills (Verbal & Written)

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• Telephone Etiquette

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• Active Listening Skills

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The following requirements are advantageous:

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• 1 – 2 years ICU experience

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• Knowledge of DH SOP’s and Process experience (internal only)

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• Provider payment arrangements (internal Only)

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• Clinical coding knowledge of ICD-10 and/or CCSA

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