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.