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Consultant : Medical Management X2
Road Accident FundCenturion, ZA19 days ago
Job descriptionConduct 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. Pre-authorise 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. Ensure the implementation and maintenance of a formal exception handling process within the medical management. Maintain the documentation and regular updating of the exception handling process. Maintain the implementation an unusual occurrence procedures. Track and report against set objectives and targets. Report on emerging risks. Provide ad-hoc reports on process improvement initiatives. Produce documents, briefing papers, reports and presentations. Deal with / and respond to correspondence. Maintain healthy relationships with all stakeholders. Follow up and making recommendations on which corrective actions are appropriate. Follow up and feedback to all stakeholders to keep them updated on the status of a query. Respond to queries within the predefined turnaround times. Bachelor’s Degree / Advanced Diploma in Health Sciences / Medical related qualification. Registration with HPCSA / SANCA. Relevant 3 years’ experience in A Medical related environment. Claims management process / processes and systems. Medical product management. Medical bill reviewing Medical case management Planning, Organising and Coordinating Personal mastery Judgment and decision making Ethics and Values Client Service Orientation Medical / Healthcare jobs
Job title : Consultant : Medical Management X2
Job Location : Gauteng, Centurion
Deadline : October 11, 2025
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- 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.
Key Performance Areas
Medical Management
Exception Handling
Reporting
Stakeholder Management
Qualifications and Experience
Technical Competencies Required
Behavioural Competencies Required
Note : THIS IS A THREE (3) YEAR FIXED TERM CONTRACT
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Management Consultant • Centurion, ZA
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