Consultant : Medical Management X20

Overview

Division : Operations

Reference No : 5996

Location : Durban, Kwazulu-Natal, ZA

Employment Type : Fixed Term Contract

Disability (EE targeted role) : Yes

T.A.S.K Grade : 11

Job Posting Salary : R501,775.00

Job Posting End Date : 15 Oct 2025

The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.

Purpose of the Job : The Consultant : Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

NB : This is a 3 Years Fixed Term Contract.

Key Performance Areas

Medical management.

• Conduct medical assessment and compile injury assessment reports.
• Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
• Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF and / or any that is considered reasonable.
• Preauthorize submitted claims aligned to RAF clinical guidelines including the RAF formulary, treatment protocols and related tariffs.
• Escalation of complex cases for multi-disciplinary review and adjudication.
• Participate in the consultations process on the implementation of medical claims processes.

Exception handling

Reporting

Stakeholder management

Qualifications And Experience

Behavioral competencies

Technical competencies

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.

Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful

Security Vetting shall be conducted on all prospective employees

It is the applicants’ responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

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