Medical Aid Verification of Benefits (VOB) Administrator

Role Overview

We are seeking a detail-oriented Medical Aid Verification of Benefits (VOB) Administrator to verify patient medical aid cover, benefits, and authorisations prior to medical services being rendered.

The role ensures accurate benefit verification, reduces claim rejections, and supports smooth billing and patient communication.

This position is critical in ensuring that medical services are aligned with the patients available benefits and medical aid rules.

Key Responsibilities

Medical Aid & Benefits Verification

• Verify medical aid membership status and plan eligibility

• Confirm covered benefits for consultations, procedures, and treatments

• Check annual limits, sub-limits, PMB eligibility, and exclusions

• Identify co-payments, deductibles, and out-of-pocket costs

• Confirm network status (DSP / in-network vs out-of-network)

Authorisations & Pre-Approvals

• Determine when pre-authorisation is required

• Assist with or submit authorisation requests where needed

• Track approval reference numbers and validity periods

Documentation & Communication

• Accurately document verified benefits and authorisations

• Communicate benefit details clearly to internal teams and/or patients

• Liaise with medical aids, administrators, and scheme call centres

• Maintain organised records for billing and audit purposes

Billing & Claims Support

• Support billing teams by ensuring services align with verified benefits

• Reduce claim rejections through proactive verification

• Assist with claim follow-ups related to eligibility or benefit disputes

Requirements

Experience

• 1–3+ years experience in:

  • Medical aid administration

  • Medical billing or healthcare admin

  • Verification of Benefits (VOB) or eligibility checks

Knowledge

• Strong understanding of South African medical aid schemes

• Familiarity with:

  • PMBs (Prescribed Minimum Benefits)

  • DSP rules

  • Pre-authorisations and benefit structures

Skills

• High attention to detail and accuracy

• Strong verbal and written communication skills

• Ability to handle confidential patient information

• Comfortable working with portals, spreadsheets, and practice systems

• Able to work independently and meet deadlines

Advantageous (Not Essential)

• Experience supporting international (US) healthcare billing

• Knowledge of medical coding (ICD-10, CPT – basic exposure)