PMB Specialist (Psych)

 

About Discovery

 

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

 

 

About Discovery Care

 

Discovery Care, a subsidiary of Discovery Health, comprises of several specialized clinical areas with segmented teams. The Chronic and PMB Management team handles the processing of Chronic and Prescribed Minimum Benefit requests and manages escalated clinical queries. The HIV/Oncology and In-Hospital Case Management teams review clinical cases specific to their areas of expertise. The High Touch team provides hands-on services and resolves escalated queries for sensitive cases. Additionally, the Hospital Benefit Specialists, as part of field force, are responsible for real-time risk management and the Care Coordination Services manages the Managed Care programs.

 

 

Key Purpose:

 

The processing of out of hospital PMB Psychotherapy applications in line with PMB protocols and in accordance with the benefit entry criteria

To assist and support the PMB Operations team with ad hoc projects and tasks

 

Key Outputs:

 

 

The successful applicant will be responsible for but not limited to the following job functions:

 

• Reviewing PMB Psych application forms and appeals from members & providers and making appropriate funding decisions by applying PMB protocols

• Working towards daily outputs of production and quality to ensure member satisfaction

• Apply government stipulations in terms of PMB’s and treatment algorithms

• Communication to external and internal parties surrounding PMB decision outcomes

• General administration

• Adhoc duties within the PMB team may be required

• Continuously updating your own knowledge relating to DH and In-House products.

 

 

 

Competencies:

 

The successful candidate must demonstrate the following competencies:

 

 

Role Specific Behaviours

☒Ensures accountability.

☒Action oriented

☒Manages ambiguity.

☐Attracts top talent.

☒Business insight

☒Collaborates

☒Communicates effectively.

☒Manages complexity.

☒Manages conflict.

☒Courage

☒Customer focus

☒Decision quality

☐Develops talent

☐Values differences

☐Directs work.

☐Drives engagement

☐Financial acumen

☐Global perspective

☒Cultivates innovation.

☒Interpersonal savvy

☒Builds networks.

☒Nimble learning

☒Organizational savvy

☒Persuades

☒Plans and aligns.

☒Being resilient

 

☒Resourcefulness

☐Drives results

☒Demonstrates self-awareness.

☒Self-development

☒Situational adaptability

☐Balances stakeholders

☐Strategic mindset

☐Builds effective teams.

☐Tech savvy

☐Instils trust.

☐Drives vision and purpose

☐Optimizes work processes

 

Education and Experience:

 

The following requirements are essential:

 

Matric Computer literacy Effective communication skills​​​​​​ Administrator, Data capture or Call Centre experience Medical scheme or Insurance experience

 

The following requirements are advantageous:

 

Understanding of DH product benefit, funding and policy rules Discovery systems knowledge Basic Clinical knowledge

 

Personal Attributes or Competency Profile

The Discovery Person

Values Driven Optimistic Learns on the Fly Resilient Instils Trust People Savvy Drives Results Problem Solver

 

 

EMPLOYMENT EQUITY   
                             
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.