Job Description

To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections by corrective action
Job description
Job Objectives:

• To resolve medical aid rejection queries with member where medical aid has no impact e.g. benefit exceeded
• To resolve medical aid rejection queries with medical scheme e.g. medication authorization
• To provide member with status update regarding rejection and resolution thereof.
• To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical aid three days prior to due date of delivery
• To resolve queries received from patients within a two hour turn-around time e.g. extended supplies due to member going oversees

Knowledge:

• IT applications areas and delivery channels (Unisolv and Marconi )
• Current IT technology (6 months)
• Medical Aid Formularies (6 months)
• Product knowledge (1 year)
• Pharmacy Council Legislation (1 year)

Skills:

• Communication skills
• Problem solving skills

Competencies:
Essential:

• Analysing
• Deciding and Initiating Action
• Adhering to Principles and Values
• Persuading and Influencing
• Working with People
• Adapting and Responding to Change
• Achieving Personal Work Goals and Objectives
• Applying Expertise and Technology
• Following Instructions and Procedures
• Delivering Results and Meeting Customer Expectations

Minimum requirements
Education:
Essential
National Senior Certificate

Skills Required