Care Manager (Contract - FAK) at Absa Bank Limited

Job Summary

Case management, handling all outpatient, inpatient, specialized services preauthorization, and communicating with providers, clients, and brokers on a timely basis as per agreed TATs.

Job Description

• To perform all the case management roles at the contact centre which includes but not limited to: 
• Immediate response to calls in relation to call centre guidelines and provide solutions to customers in a professional way.
• Respond to all emails and give feedback within the stipulated Procedures TATs. Critically analyse and give accurate response to pre-authorization within 10 minutes of receiving in line with member policy benefits.
• Negotiate with providers on All surgical cases for cost containment.  The Optometrist to handle all the optical case in addition to the assigned roles.
• The clinical officer or pharmacist to vet all prescriptions and other bills to identify any overpriced items.
• Mitigate fraud cases through visitation of admitted patients in various hospitals, and vet all inpatient bills.
• Discharge patients within 30 minutes, outpatients email response within 10 minutes.
• Daily sending of admissions reports of clients: Brokers/Agents/Company Human Resources Managers.
• Efficient & accurate submission of approvals in line with the medical policy .
• Obtaining medical information from providers with written correspondence if necessary.
• Capacity to continually apply negotiation skills with the service providers.
• Interacting with clients, Intermediaries and services providers as required to resolve problems in a manner that is legal, ethical, and consistent with the principles of the policy.
• Accurate checking and confirming membership validity, benefits and sending member statement upon enquiry.
• Accurate guidance on provider network enquiries from brokers, providers, members etc.
• Vetting and confirming validity of the service given by the service provider in relation to the member benefit covered, treatment given, adherence to provider panel rules and cost of treatment. 
• Obtaining additional required information on invoice/claims from providers or clients.