Medical Scheme jobs in Cape Town, Western Cape
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- Discovery Ltd.Milnerton, Western Cape 7446
- Confirming Inhouse scheme benefits according to set protocols and funding rules.
- Accurately obtaining and capturing information to confirm correct Inhouse…
- Momentum HealthBellville, Western Cape
- 1-3 years of experience in the medical aid industry is essential.
- 2-3 years of Claims processing experience within the medical aid industry is essential.
- View all Momentum Health jobs - Bellville jobs
- Salary Search: Claims Specialist salaries
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- Western Cape Government Department of Health and...Western Cape
- Ability to work with Excel spread sheets, Microsoft Word and web-based programs (medical aids).
- R 413 001 - R 486 501 per annum Annual salary plus service…
- Western Cape Government Department of Health and...Western Cape
- Ability to work with Excel spread sheets, Microsoft Word and web-based programs (medical aids).
- R 413 001 - R 486 501 per annum Annual salary plus service…
- WorkabilityCape Town, Western Cape
- Experience in healthcare, rehabilitation, medical schemes, managed care, or patient engagement.
- Contract Period:* 1 December 2026 to 31 May 2027 (six months).
- Medway MarketingCity Bowl, Western Cape
- Financial services or the medical scheme industry.
- Matric (Grade 12) and at least 8 years’ experience in financial services or the medical scheme industry.
- NMICape Town, Western Cape
- Employee referral scheme with generous financial reward.
- Annual bonus scheme (dependent on company and individual performance).
- Good enough isn't enough.
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- Momentum HealthBellville, Western Cape
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- MRI SoftwareCape Town, Western Cape
- The Project Coordinator will be part of a centralised pool, providing flexible project coordination services to the wider Professional Services Department and…
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- Sonata OneCape Town, Western Cape
- Fund managers can raise capital faster at a lower cost from a wider pool of pre-approved investors.
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- Melomed Private Hospitals SASouthern Suburbs, Western Cape
- Control outstanding medical aid accounts by processing and submitting all medical aid claims within the required time frame.
- MRI SoftwareCape Town, Western Cape
- You’ll work closely with Consultants, Project Managers and subject matter experts to turn complex information into clear, engaging and professionally structured…
- AstraZenecaCape Town, Western Cape
- At private sector may be required to handle basic managed healthcare (medical aid scheme) discussions at the doctor’s practice.
- MRI SoftwareCape Town, Western Cape
- This role is ideal for someone who can independently analyse complex issues and deliver data-driven solutions to clients.
- MRI SoftwareCape Town, Western Cape
- The Billing Specialist will be working with the core business team as well as supporting any acquired entities’ AR portfolios.
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Job Post Details
Pre Auth Service Consultant - Inhouse
Milnerton, Western Cape 7446
Pre Auth Service Consultant - Inhouse
Job details
Pay information not provided
Milnerton, Western Cape 7446
Full job description
Business Unit: Discovery Health
Function: Call Center / Contact Center
Date: 10 Oct 2026
Key Purpose
To deliver world class service to all Inhouse scheme stakeholders (Members, Providers, Employer groups, Hospitals, and Brokers) by supporting and fully resolving their queries through various servicing channels, primarily over the telephone.
To effectively manage the risk of benefit authorisations (funding from risk) by using your clinical knowledge and integrating this with your understanding of the benefits of the scheme and ensuring accurate information regarding funding
Key outputs
The successful applicant will be responsible for but not limited to the following job functions:
- Confirming Inhouse scheme benefits according to set protocols and funding rules
- Accurately obtaining and capturing information to confirm correct Inhouse scheme funding
- Servicing all Inhouse scheme stakeholders telephonically and via other servicing channels until the query has been resolved
- Servicing Inhouse scheme
- stakeholders in a customer centric way to ensure that we live by our service principles
- Keeping up to date with product changes and benefits to ensure that all stakeholders are accurately serviced
- Continuously staying abreast of all digital servicing tools within the business and ensuring that the functionality is fully understood
- Achieving and exceeding key performance metrics relating to service delivery
- Keeping abreast of continuous process, product updates and digital tools
- Dealing with multiple interactions
- Consistently utilizing all servicing tools available
- Ensuring excellent quality service to all callers
- Identifying and reporting back on issues identified with systems
- Maintaining the brand as set out by the various schemes
- Routing all enquiries to correct departments, where applicable
- Assisting with CRM queries daily
- Must be willing to work overtime where necessary
- Attend additional training outside of working hours including weekends
Competencies and Skills
Behavioural Competencies
- Following instruction and procedures (Self-development)
- Analysing (Managing Complexity)
- Learning and Researching (Nimble Learning)
- Presenting and communicating information (Communicating effectively)
- Delivering results and meeting customer expectations (Customer focus)
- Deciding and initiating action (Decision Quality)
- Working with people (Collaborating)
- Writing and reporting (Communicating effectively)
- Clinical Knowledge
- Adapting and responding to change
- Persuading and influencing
- Adhering to principles and values
- Achieving personal work goals and setbacks
- Resolution driven
Knowledge
- Anatomy and Physiology
Skills
- Time Management
- Verbal and written communication
- Computer Literate with MS Office and Outlook skills
Personal Attribute and Skills:
- Customer Centric
- Knowledge of Anatomy and Physiology
- Time Management
- Living Discovery Values
- Discovery person traits
- Empathetic
- Resilience
Education and Experience
Education:
- Matric
- South African accredited Clinical Qualification- HR to provide minimum requirement
Experience
- At least 6 months working experience in a customer services or clinical environment
EMPLOYMENT EQUITY
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.
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