Introduction
Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health 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
To collaborate professionally with healthcare providers, members and pharmacies to guarantee the correct authorisation and funding of medications prescribed.
Requirements
A National Senior Certificate is essential
Post-basic Pharmacist Assistant registered with the South African Pharmacy Council is essential
5 Year's retail pharmacy experience is essential
Experience in a call centre or client services environment with proven knowledge of customer service principles and practices is preferred
Exposure to the medical scheme industry is advantageous
Exposure to Prescribed Minimum Benefits is advantageous
Microsoft 365 proficiency – with Excel at an intermediate level
Duties & Responsibilities
Engage with members and providers in a professional manner to resolve all queries within the Service Level Agreement and quality standards.
Take ownership of complaints and ensure they are resolved timeously and effectively.
Provide all stakeholders with the relevant information and documentation as required.
Review and verify the eligibility and coverage of prescribed medications.
Accurate capturing and updating of chronic applications on relevant system/s, within required turnaround times.
Accurate completion of administrative and reporting requirements within agreed timeframes.
Adhere to legislative / compliance requirements in the pharmacy benefit management process.
Identify and report process and system failures and enhancements to improve member and provider experience.
Escalate queries to the relevant team or stakeholder when necessary.
Build and maintain relationships with clients, internal and external stakeholders.
Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional customer service.
Develop and maintain productive and collaborative working relationships with peers and stakeholders.
Positively influence and participate in change initiatives.
Contribute to continuous innovation through the development, sharing and implementation of new ideas.
Take ownership for driving career development.
Competencies
Accountability
Effective verbal and written communication skills
Customer service skills
Time management
Attention to detail
Teamwork and cooperation
Business administration skills
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