About This Role
This role focuses on educating members to mitigate health risks, aiming to reduce hospitalizations, mortality, and health degradation, thereby controlling costs. It suits a counselor with clinical experience in patient care.
Responsibilities
- Follow procedures and cooperate with peers and leaders for optimal service delivery
- Maintain defined legal, statutory, and regulatory compliance at required standards
- Comply with operational risk and governance structures, measures, and frameworks, taking necessary action to address issues
- Contribute to cost savings within the department to assist with financial goals and targets
- Meet delivery objectives by working with other team members within and linked to the department/project
- Resolve operational performance variations and problems, escalating unresolved issues to higher levels
- Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery
- Keep up to date with operational changes implemented in response to important external influences
- Deliver in a manner that supports and meets operational quality standards and defined departmental priorities
- Perform according to defined operational best practice and identify and implement opportunities for continuous delivery improvement
- Deliver personal performance within Human Capital frameworks and policies to ensure delivery to agreed standards and objectives
- Engage in development, coaching, and mentoring
- Support transformation through valuing diversity
- Behave in alignment with Afrocentric values
- Ensure appropriate, active, and informative relationships with customers and relevant stakeholders are successfully achieved
- Address customer or stakeholder complaints in alignment with policies and procedures, ensuring customer/stakeholder buy-in
- Provide appropriate and impactful telephonic and written counseling, education, and support to allocated clients with high-risk or long-term illnesses
- Complete required administration and case information on assigned cases to standard and within deadline
- Handle and resolve medical and claim-related fund queries
- Refer high-risk patients to alternative professionals for additional support (such as social workers)
Requirements
- Relevant B Psych degree
- Current registration with Health Professions Council of South Africa (HPCSA)
- 2-3 years of counseling in a hospital or clinical experience, providing patient care
- Application of financial and risk assessment methodology
- Knowledge of scheme rules and contractual negotiations
