Hospital Benefit Specialist – KZN at Discovery Limited

Company: Discovery Limited

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Discovery Limited

Industry: Insurance

Posted: Sep 8, 2025

Deadline: Not specified

Job Type: Full Time

Qualification: Matric

Experience: 3 years

Location: KwaZulu-Natal

City:

Field: Medical / Healthcare

Key Purpose:

  • The successful applicant will be responsible for but not limited to the following job functions:

Assessing the case in relation to the following:

  • Members clinical history
  • Members benefit structure
  • Clinical Information and coding supplied
  • Level of care provided
  • Appropriateness of the facility
  • Appropriateness of the treating doctor
  • Appropriateness of treatment
  • 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
  • Discharge planning by providing the member with alternatives to receive treatment (This includes Hospital @ Home, Homecare etc.)

Effective and accurate communication to all stakeholders:

  • Case update to the provider
  • Funding decisions and benefit confirmation to the members
  • Request for additional information from the treating doctor or practice manager
  • Engaging with Patient Services Manager and hospital staff
  • Handling escalations from Providers and internal stakeholders
  • Preparing and presenting complex case to clinical review
  • Trend Analysis of inefficiencies and proposals to correct
  • Appropriate internal case referrals for clinical management

Operational Targets:

  • Attend to patients on daily report
  • Review all low acuity admission requests
  • Quality of processes

Competencies:

The successful candidate must demonstrate the following competencies:

Role Specific Behaviours

  • Ensures accountability.
  • Action oriented
  • Manages ambiguity.
  • Attracts top talent.
  • Business insight
  • Collaborates
  • Communicates effectively.
  • Manages complexity.
  • Manages conflict.
  • Courage
  • Customer focus
  • Decision quality
  • Develops talent
  • Values differences
  • Directs work.
  • Drives engagement
  • Financial acumen
  • Global perspective
  • Cultivates innovation.
  • Interpersonal savvy
  • Builds networks.
  • Nimble learning
  • Organizational savvy
  • Persuades
  • Plans and aligns.
  • Being resilient
  • Resourcefulness
  • Drives results
  • Demonstrates self-awareness.
  • Self-development
  • Situational adaptability
  • Balances stakeholders
  • Strategic mindset
  • Builds effective teams.
  • Tech savvy
  • Instils trust.
  • Drives vision and purpose
  • Optimizes work processes

Education and Experience:

The following requirements are essential:

  • Matric
  • Must be a Registered Nurse
  • Valid SANC Registration
  • 3 years Clinical experience in a private hospital setting (ICU, Trauma/Casualty, Medical/General ward preferable)
  • 2 years Managed health care experience 
  • Microsoft Office (Specifically Excel experience)
  • Valid Driver’s License and own transport ( working hours are between 08:30 -17:00 & travel up to 50KM may be required)
  • Effective Communication Skills (Verbal & Written)
  • Telephone Etiquette
  • Active Listening Skills

The following requirements are advantageous:

  • 1 – 2 years ICU experience
  • Knowledge of DH SOP’s and Process experience (internal only)
  • Provider payment arrangements (internal Only)
  • Clinical coding knowledge of ICD-10 and/or CCSA

Click here to apply

  • Members clinical history

    • nt

  • Members benefit structure

    • nt

  • Clinical Information and coding supplied

    • nt

  • Level of care provided

    • nt

  • Appropriateness of the facility

    • nt

  • Appropriateness of the treating doctor

    • nt

  • Appropriateness of treatment

    • nt

  • 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

    • nt

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

    • n

    nn

    Effective and accurate communication to all stakeholders:

    nn

      nt

    • Case update to the provider

      • nt

    • Funding decisions and benefit confirmation to the members

      • nt

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

      • nt

    • Engaging with Patient Services Manager and hospital staff

      • nt

    • Handling escalations from Providers and internal stakeholders

      • nt

    • Preparing and presenting complex case to clinical review

      • nt

    • Trend Analysis of inefficiencies and proposals to correct

      • nt

    • Appropriate internal case referrals for clinical management

      • n

    nn

    Operational Targets:

    nn

      nt

    • Attend to patients on daily report

      • nt

    • Review all low acuity admission requests

      • nt

    • Quality of processes

      • n

    nn

    Competencies:

    nn

    The successful candidate must demonstrate the following competencies:

    nn

    Role Specific Behaviours

    nn

      nt

    • Ensures accountability.

      • nt

    • Action oriented

      • nt

    • Manages ambiguity.

      • nt

    • Attracts top talent.

      • nt

    • Business insight

      • nt

    • Collaborates

      • nt

    • Communicates effectively.

      • nt

    • Manages complexity.

      • nt

    • Manages conflict.

      • nt

    • Courage

      • nt

    • Customer focus

      • nt

    • Decision quality

      • nt

    • Develops talent

      • nt

    • Values differences

      • nt

    • Directs work.

      • nt

    • Drives engagement

      • nt

    • Financial acumen

      • nt

    • Global perspective

      • nt

    • Cultivates innovation.

      • nt

    • Interpersonal savvy

      • nt

    • Builds networks.

      • nt

    • Nimble learning

      • nt

    • Organizational savvy

      • nt

    • Persuades

      • nt

    • Plans and aligns.

      • nt

    • Being resilient

      • nt

    • Resourcefulness

      • nt

    • Drives results

      • nt

    • Demonstrates self-awareness.

      • nt

    • Self-development

      • nt

    • Situational adaptability

      • nt

    • Balances stakeholders

      • nt

    • Strategic mindset

      • nt

    • Builds effective teams.

      • nt

    • Tech savvy

      • nt

    • Instils trust.

      • nt

    • Drives vision and purpose

      • nt

    • Optimizes work processes

      • n

    nn

    Education and Experience:

    nn

    The following requirements are essential:

    nn

      nt

    • Matric

      • nt

    • Must be a Registered Nurse

      • nt

    • Valid SANC Registration

      • nt

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

      • nt

    • 2 years Managed health care experience 

      • nt

    • Microsoft Office (Specifically Excel experience)

      • nt

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

      • nt

    • Effective Communication Skills (Verbal & Written)

      • nt

    • Telephone Etiquette

      • nt

    • Active Listening Skills

      • n

    nn

    The following requirements are advantageous:

    nn

      nt

    • 1 – 2 years ICU experience

      • nt

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

      • nt

    • Provider payment arrangements (internal Only)

      • nt

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

      • n

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