Preauthorization Administrator MMH260702-4

Role Purpose

To efficiently review, process, and manage dental pre-authorisation requests within service level agreements (SLAs) and according to company policies and regulatory requirements. The primary focus is on accurately assessing and capturing pre-authorisations from multiple platforms, ensuring compliance with clinical protocols and scheme rules, while supporting timely and appropriate member care.

Requirements Qualification

• Matric Certificate (Essential).
• Relevant tertiary qualification – Dental Assisting, healthcare administration or equivalent.

Experience

• Minimum 2 years’ experience in dental administration.
• Prior experience in medical aid benefits, billing, and claims processing.
• 1–3 years’ experience in Managed Care Operations or Pre-Authorisation.
• Strong understanding of medical scheme protocols and benefit structures

Duties and Responsibilities

• Accurate and timely capture and assessment of dental pre-authorisation requests.
• Effective resolution and reporting of system issues.
• Completion and documentation of pre-authorisation batches.
• Clear communication of assessment outcomes to stakeholders.
• Identification of potential clinical or fraud risks based on request trends.
• Consistent achievement of productivity and quality standards.

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