Description : Administration Coordinator. Company : Health Solutions. Location : Eastern Cape

Introduction

Momentum Health Solutions (MHS), an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health and wellness solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.

Role Purpose

Provide high quality administrative support to the Specialised Health Team to ensure that the Team meets the required service level agreements.

Requirements

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  National Senior Certificate with a minimum achievement level of 4 (50%) for Mathematical Literacy or 3 (40%) for Mathematics
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  Language proficiency in English and one other official South African language is essential
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  Relevant tertiary qualification would be advantageous
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  MS Office proficiency (Advanced Excel certificate would be advantageous)
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  Minimum of 5 years’ experience in a medical scheme administration environment
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  Understanding of a medical scheme administrators’ role and the related terminology and processes is essential

Duties & Responsibilities

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  Client Administration / Co-ordination
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    Loading discounts and benefits as necessary.
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    Ensure that reports are actioned as scheduled.
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    Accurate loading of benefit limits / discounts as applicable.
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    Co-ordinate any report requests between Clients and IT.
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    Ensure that reports are actioned as scheduled and highlight any discrepancies.
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    Check and approve release of various payment files.
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    Scheduling of weekly special / ad hoc payments for clients.
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    Negotiate discounts on costs above scheme rate and submit requests for additional payments to the relevant stakeholder.
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    Monitor scheduling of reports to clients and request changes as needed.
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    Loading of formulary items.
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  Customer Care Services
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    Resolve telephonic provider / client queries within key performance indicator.
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    Resolve written provider / client queries within key performance indicator.
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    Investigation and resolution of escalated email and telephone queries.
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    Check and sign off journals.
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    Ensure tickets are responded to within turnaround time.
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  Provider Relations
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    Assist with follow-up and filing of new preferred provider agreements.
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    Schedule provider profiling reports and analyse on a basic level.
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    Loading / terminating of provider contracts for different schemes.
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    Manage provider relations tickets.
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    Bulk tariff importing and reporting.
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  International Organization for Standardization (ISO) Quality Management System
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    Understand and consistently meet the relevant requirements.
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  Prescribed Minimum Benefits (PMB) Application Review
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    Review and finalise cases.
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    Escalate complicated cases for further review and assistance.
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    Capturing of PMB journals.
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    Provide formal feedback to providers and members.

Competencies

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  Meticulous attention to detail
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  Ability to work independently
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  Excellent verbal and written communication
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  Ability to work quickly and accurately
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  Strong analytical skills
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  Excellent relationship building skills
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  Business administration skills
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  Forward thinking / displays initiative