Seth Abrahams

Experience

• 

  Asda

  May 2008 - Nov 2010

  Team Leader

  Overseeing the daily operations of the pre-authorisatons/ accounts division of the company. Responsible for the guidance/coaching and growth of team and Department.

• 

  Discovery Limited

  Nov 2010 - Nov 2017

  Reviewing and assessing emergency PMB admissions, updating authorisations with the appropriate level of care, ICD 10 codes/CPT codes. Updating authorisations received from the various hospitals. Explaining PMB funding to patients to ensure that they understand PMB regulations in correlation with scheme rules and protocols. Facilate movement to a DSP providers where applicable. Various adhoc functions. Understanding and applying the PMB CLD protocols. Applying the SAOC and DUR protocols for oncology patients. Keeping track of the latest treatments/ guidelines and medications available.

  • PMB Specialist

    Apr 2014 - Nov 2017

  • Chronic, HIV and Oncology Specialist

    Nov 2010 - Mar 2014
• 

  Xpedient

  May 2018 - now

  The Clinical Services & Scheme Liaison Manager plays a critical role in the medical industry by overseeing complex PMB-related queries, Medical Scheme claims, and Client engagement. The role requires a deep understanding of PMB legislation and guidelines, as well as the ability to make accurate, evidence-based decisions. Manage and develop an experienced team of clinical and non-clinical professionals. Overseeing this team is crucial to its success and requires a combination of leadership skills, technical expertise, and strong communication abilities.Managing and fostering relationships with Medical Schemes by communicating, collaborating, and developing effective solutions. Being proactive, solution-focused, and able to make informed decisions help build strong relationships and promote the success of the organization while delivering high-quality services to clients. Positive and productive partnerships are key to achieving goals and delivering outstanding results. Show less Ensure compliance with established internal control procedures by examining records, reports, operating practices. Complete audit workpapers by documenting audit tests and findings.Review the accounts of clients to ensure that procedures and protocols are followed. Act in an advisory role and recommend possible risk aversion measures and cost savings that could be made - preparing reports, commentaries and financial statements. Investigate, resolve high level escalations. Ensure all decisions and responses are aligned with the Medical Schemes Act and Prescribed Minimum Benefits protocols and procedures. Liaise with Fund Management, Principal Officers and key Stakeholders at respective medical schemes. CMS case managemnt. Project Management. Various adhoc functions. Show less

  • Clinical Services & Scheme Liaison Manager

    Aug 2022 - now

  • Auditor | Schemes & CMS Liaison

    May 2018 - Aug 2022