Council For Medical Scheme jobs

Clicks Group

To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections by corrective action.

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