Job Description

• A financial services business is seeking to appoint a Consultant Medical Management – 3 Year Contract.
• The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

Qualifications:

• Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
• Registration with HPCSA/SANCA
• 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.
• Pre-authorise submitted claims
• Escalation of complex cases for multi-disciplinary review and adjudication.
• Participate in the consultations process on the implementation of medical claims processes.

Experience:

• Relevant 3 years’ experience in a Medical related environment
• Claims management process/ processes and systems.
• Medical product management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Customer value proposition
• Strong clinical analytical capabilities
• Knowledge of motor vehicle accident legislation
• Planning, Organising and Coordinating.
• Personal Mastery.
• Judgement and Decision Making.
• Ethics and Values.
• Client Service Orientation.