Specialist Authorisation Agent

Location: Centurion, Gauteng

Position Purpose: To ensure the accurate issuing of appropriate pre-authorisations that meet the requirements of clinical appropriateness, medical necessity and clinical risk management.

Experience: 2 to 5 years' solid experience within a medical aid administration environment.

Qualifications: Grade 12 and relevant tertiary qualification.

• Handle inbound and outbound calls relating to pre-authorisation requests.
• Capture, validate, and process benefit authorisations accurately.
• Liaise with members, healthcare providers, and internal stakeholders to ensure efficient service delivery.
• Provide clear and professional communication regarding benefit limits, exclusions, and scheme rules.
• Escalate complex queries to the clinical team where required.
• Maintain accurate records and adhere to company policies, procedures, and service level agreements.

Skills and Abilities

• Attention to Detail - ensures accuracy in capturing and processing data.
• Customer Service Orientation - professional, empathetic, and solution-driven approach.
• Problem-Solving - able to resolve queries effectively within policy guidelines.
• Time Management - manages workload efficiently and meets deadlines.
• Teamwork & Collaboration - works well with colleagues and supports a positive team culture.
• Adaptability - remains resilient and focused in a fast-paced environment

Knowledge

• Knowledge of medical aid rules, ICD-10 codes.
• Strong computer literacy and data-capturing skills.
• Excellent communication skills (verbal and written).
• Ability to work in a structured, high-volume call centre environment
• Knowledge and application of relevant legislation
• Knowledge and application of scheme rules

Note: Company reserves the right to close the advert before specified closing date.

PHA has its head office in Westville, KwaZulu-Natal. It operates country-wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.