Pre-Authorisation Administrator

Momentum Health

Centurion, Gauteng

Permanent

Closing Date: 2026/01/29

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

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

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

• Accurately capture dental pre-authorisation requests on various platforms.
• Verify patient, provider, procedure, and insurance details to ensure completeness and accuracy.
• Perform initial checks to prevent duplicates and ensure smooth processing.
• Assess all dental pre-authorisation requests against established clinical protocols and scheme rules.
• Review clinical documentation including treatment plans and supporting clinical notes.
• Make informed decisions to approve, query, or reject requests in accordance with guidelines.
• Communicate assessment outcomes clearly and promptly to providers and members.
• Identify and report any system discrepancies or technical issues encountered during pre-authorisation processing.
• Collaborate with IT and support teams to resolve system issues promptly and minimize workflow disruption.
• Record and log batch details and processing times on dashboards for tracking and reporting.
• Demonstrate proficiency in using all relevant pre-authorisation platforms.
• Stay updated on platform changes, enhancements, and best practices to ensure efficient processing.
• Maintain clear and accurate documentation of all pre-authorisation activities and decisions.
• Liaise effectively with internal departments (e.g., Claims, Customer Service, Provider Relations) to ensure coordinated service delivery.
• Identify trends or anomalies in pre-authorisation requests that may indicate clinical concerns or potential fraud.
• Meet daily productivity targets by processing a minimum of 60 pre-authorisation requests per day.
• Manage workload effectively to maintain accuracy while achieving volume goals.

Competencies

• Strong attention to detail and accuracy.
• Good organizational and time management skills.
• Ability to navigate and utilize multiple digital platforms.
• Clear and professional communication skills.
• Sound understanding of dental clinical protocols and scheme rules.
• Analytical mindset to identify trends and risks.
• Ability to work collaboratively across departments.
• Proactive approach to problem-solving.