Duties:
Assist with and improve wellness and disease management programmes
Devise methods to manage and implement beneficiary disease registration and reimbursement with all parties involved
Analyse clinical data, utilisation of funds etc. of members and healthcare providers
Facilitate beneficiary registrations or chronic medicines
Coordination of annual wellness screenings and health days
Liaison with the internal team to manage and provide optimal care to members
Liaison with members to ensure adequate funding, compliance and current se of benefits
Identification of trends, abuse and fraud related to benefits
Maintain and update data on the system
Attend to queries, requests and resolve within business rules
Review approved claims, applying knowledge of Nappi codes and tariffs
Monthly reporting, including chronic medication benefits, registrations and compliance
Qualifications:
Matric + Pharmacy Assistant qualification, current registration with SA Pharmacy Council
5+ years Pharmacy Assistant experience
Claims processing, auditing, and risk management experience / qualification
Knowledge of SA Health Industry, medical aid options and benefits
Knowledge of ICD 10 codes, RPL tariffs
Understand evidence-based medicine principles and healthcare funding
Excellent written and verbal communication
Computer literate, MS Office and database
