Case Coordinator

Main Duties: Analyses all requests submitted by service providers, members and ensure correct awards are given on quotations for procedures. Checks on the correct use of tariffs on quotations and rejects where services are inappropriate. Captures all the Cases on the system and issues Personal Identification Numbers to cases admitted. Advises members and service providers on awards payable. Receives and resolves preauthorization queries from services providers and members. Attend to walk-in clients and manage the front office desks. Escalates complicated queries and complaints to Team Lead Case Coordination. Refers chronic cases and high cost cases to the Disease Management team for further follow up. Initiate Case submissions on appeals from members and service providers for approval by the Head Managed Care. Refers Cases of over-servicing and suspected fraudulent activities to Team Lead Case Coordination for further analysis. Prepares and submits monthly reports to the Team Lead Case Coordination on preauthorised Cases. Qualifications: Diploma in Nursing/Health Sciences or the equivalent At least 2 years case management experience