Specialist Authorisation Agent

Position: 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.

KEY PERFORMANCE AREAS

• 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 re...