Call center Nurse

Lets Write Africa's Story Together!Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.Job DescriptionPurpose and description of the roleTo manage medical benefit utilization through supervision of pre-authorization answer queries over the phone and give timely solutions to the customer.Key outputsThe following key outputs are required from this role. Pre-Authorization of all admissions within 6 hours and technical guidelines. Minimize identifiable cases of fraud/abuse Deliverables (work elements)The following detailed outputs are required from this role. To resolve customer queries over the phone and offer solutions to the customers in a timely manner Supervise Pre-authorization of scheduled and non-scheduled admissions within the set guidelines and carry out verification and medical Audit of claims/invoices before settlement. Managing requests for services from providers, intermediaries and clients, providing information on the UAP Old Mutual provider network and available benefits per scheme policy In conjunction with SMART applications resolve card issues raised at the point of service Authorization of all optical requests from the different providers within 6 hours and prepare daily reports To attend to reimbursements from the different providers in a timely manner and provide daily reports. Liaise with other medical schemes for purposes of evaluating medical risk. To formulate committal letters of discharges as a result of the requests from the different service providers. The incumbent will be responsible for ensuring adherence to, implementation of, and adoption of Compliance, Anti-Money Laundering (AML), and Sanctions-related policies, procedures, and process requirements within Old Mutual and its subsidiaries. This includes execution of customer due diligence processes, ensuring compliance with Know-Your-Customer (KYC) standards, conducting ongoing and enhanced due diligence, and maintaining data quality. Additionally, the role involves identifying and monitoring potential AML, Sanctions, or Compliance breaches and unusual activities, and escalating these concerns to the Risk and Compliance Office for further action.Key competenciesThe following key behavioural competencies are required to be successful in this role. Excellent communication and negotiation skills To always keep time at the start of your shifts. Excellent public relations and interpersonal relationship skills Excellent networking with SP and other medical insurers Excellent analytical and monitoring skills Ability to work with speed and accuracy Strong Computer skills in Ms Word, Excel, Power Point and Ms Outlook Result – oriented, adheres to turn around times Strong teamwork spiritQualificationDegree or Diploma in NursingProvides a service as a temporary employee covering many fields.SkillsAnalytical Thinking, Analytical Thinking, Call Center, Communication, Computer Literacy, Customer Due Diligence (CDD), Customer Queries, Daily Reporting, Data Quality, Data Query, Deliverables Management, Due Diligence, Enhanced Due Diligence, Ensure Compliance, Interpersonal Relationships, Invoices, Know Your Customer (KYC), Microsoft Excel, Microsoft Outlook, Negotiation, Nursing, Point of Service, Public Relations (PR), Reimbursement, Risk Compliance {+ 3 more}CompetenciesEducationDiploma (Dip): Nursing (Required)Closing Date11 November 2025 , 23:59The Old Mutual Story!