Wellness Specialist

Duties:

Assist with and improve wellness and disease management programmes

Devise methods to manage and implement beneficiary disease registration and reimbursement with all parties involved

Analyse clinical data, utilisation of funds etc. of members and healthcare providers

Facilitate beneficiary registrations or chronic medicines

Coordination of annual wellness screenings and health days

Liaison with the internal team to manage and provide optimal care to members

Liaison with members to ensure adequate funding, compliance and current se of benefits

Identification of trends, abuse and fraud related to benefits

Maintain and update data on the system

Attend to queries, requests and resolve within business rules

Review approved claims, applying knowledge of Nappi codes and tariffs

Monthly reporting, including chronic medication benefits, registrations and compliance

Qualifications:

Matric + Pharmacy Assistant qualification, current registration with SA Pharmacy Council

5+ years Pharmacy Assistant experience

Claims processing, auditing, and risk management experience / qualification

Knowledge of SA Health Industry, medical aid options and benefits

Knowledge of ICD 10 codes, RPL tariffs

Understand evidence-based medicine principles and healthcare funding

Excellent written and verbal communication

Computer literate, MS Office and database