Clinical Appeals & CMS Case Coordinator

Private Health Administrators (Pty) Ltd is seeking a clinical assessor to provide expert evaluation and decision support for ex gratia applications, CMS complaints, appeals and disputes. You will review clinical documentation, apply PMB regulations, and ensure compliant, well-motivated decisions.

Responsibilities include managing CMS escalations, drafting responses, liaising with providers and internal teams, and maintaining auditable case records in line with Medical Schemes Act.

#J-18808-Ljbffr