Consultant: Clinical Auditor

7 months ago


Centurion, South Africa PPS Recruitment Full time

**Job Advert Summary**:
Applications are invited for the above-mentioned position, to be filled as soon as possible.

**Minimum Requirements**:

- Nursing qualification.
- Clinical Auditing experience
- Minimum of 2 years' experience in the managed care environment

**Duties and Responsibilities**:

- Conduct clinical audits on claims and costs to ensure correct payment of claims to providers and members
- Accumulate/Investigate data using clinical experience to highlight risks and trends which might influence the costs to the scheme
- Compile audit reports to point out trends and risks
- Liaise with providers to develop and maintain relationships
- Assist in the settlement of claims disputes to ensure correct payment of claims
- Research new medical and surgical instrumentation and products to keep the company abreast of changes in the industry
- Provide Clinical input into work directives and protocols to assist PMSA with clinical decisions
- Participate in negotiations with service providers in order to assist the Scheme with the cost effective management of resources
- Required to assist with the review of policies, protocols and formularies from a clinical and financial position
- Evaluate current medicine usage trends and compare with those of local and international sources for best practice
- Monitor medical literature and use evidence-based principles to generate enhancements in funding protocols
- Review and research new drug trial results, in collaboration with the Medical Advisor
- Answer clinical queries from Providers within the Schemes' SLA requirements
- Perform tasks timeously and with necessary detail in response to issues raised
- Provide input and support to the Clinical Committees, MHC meeting and other committees as and when required
- Assisting with all adhoc requests on any clinical matters when required
- Maintain information gathered on knowledge management portals
- Proactively identify and manage potential problems/escalations within customer base with appropriate resolution plans



  • Centurion, South Africa Affirmative Portfolios Full time

    **Medical / Emergency / Health / Lab** **Centurion - Gauteng** ***: **Senior Manager Clinical Consulting Services - Centurion** **Salary: R1,457,357.00pa CTC** **Overview**: The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolio to ensure medical scheme members are protected and...


  • Centurion, South Africa Bontle consulting Full time

    The purpose of the job is to oversee the provision of Clinical services, administer the Prescribed Minimum Benefits (PMB) portfolio to ensure medical scheme members are protected and their entitlements are guaranteed, and to develop and implement the Prescribed Minimum Benefits regulation strategy. As a Senior Manager: Clinical Consulting Services you will...

  • Clinical Consultant

    3 weeks ago


    Centurion, South Africa Health Solutions Full time

    **Introduction** - Momentum Health Solutions, anentity of Momentum MetropolitanHoldings Limited deliverssustainable, integrated healthsolutions that meet the needs ofclients in different segments andmaximise lifetime client value. Webuild and maintain a culture ofinnovation, and create valuethrough unique insights of how toachieve specific outcomes byusing a...


  • Centurion, South Africa FHI Clinical Inc Full time

    **Summary of The Position**: The Medical Writing Manager is tasked with the writing of trial-related documentation for clinical projects undertaken by the Company in accordance with ICH GCP and local legal requirements, European, FDA and other international guidelines, as well as Company (and sponsor, if applicable) Procedural Documents. The Medical Writing...

  • IT Auditor

    6 hours ago


    Centurion, South Africa Network Recruitment (South Africa) Full time

    One of the leading financial service providers in Africa is looking for a Senior IT Auditor to join their team. This role is for an independent worker who is tech savvy and can creatively tackle unique challenges. If you are looking for broad exposure, this organisation has subsidiaries in diverse industries that will allow you to test your skills in...

  • IT Auditor

    1 week ago


    Centurion, South Africa Network Recruitment (South Africa) Full time

    Go into an environment that will challenge your IT Audit skill and provide you with broad exposure. An Audit firm with a national footprint is looking for a skilled IT Auditor who can think out the box and can operate fairly independently. You must be able to conduct ITGC, Application controls and Project Assurance. **Requirements**: - A relevant degree -...


  • Centurion, South Africa Novasyte Full time

    Job Overview Corrective and Preventative Action (CAPA) and Effectiveness Check (EC) plan review, approval and closure and Audit plan development. Provide consultation in interpretation of regulations, guidelines, policies, and procedures. Support management in promotion and assessment of compliance to regulations, guidelines and corporate policies,...


  • Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: **Minimum Requirements**: - Grade 12 - Clinical qualification for example nursing - Data analytics qualification will be an advantage. - Industry/legislation and regulations essential - ISO Principles - Essential: Medical Scheme administration/managed Healthcare experience 3+ years - Essential: Reporting experience - Reporting...

  • Internal Auditor

    8 months ago


    Centurion, South Africa Hello Group Recruitment Full time

    **Job Advert Summary**: The key function of an Internal Auditor is to manage and supervise all internal auditing activities for the business. The Internal Auditor’s role is to analyse the financial processes of a company, identifying risk within business practices and evaluating the controls put in place to counter these. Main duties include planning and...

  • Clinical Psychologist

    6 hours ago


    Centurion, South Africa Hire Power Recruitment Full time

    **THE ROLE**: - Your role is to ensure that management services are provided efficiently and effectively. This includes but is not limited to managerial consultations which could lead to managerial referrals. - The role includes session allocations to ensure that cases are managed in real-time and according to set service level agreements. - You will manage...

  • Claims Auditor

    6 days ago


    Centurion, South Africa Fempower Personnel Full time

    Gauteng - , - Centurion - Annually - (Market related) - Our prestigious client in Financial Public Sector has an EE opportunity available for a Claims Auditor to be based in the Centurion area. - Education and Experience Requirements: - Commercial Degree (BCom/Business Management/Economics/Law/Risk Management) - 3-5 years experience in short term and/or...


  • Centurion, South Africa PPS Recruitment Full time

    **Job Advert Summary**: An exciting opportunity for an analytical and attention-to-detail Pre The position reports directly to the Service Manager: Hospital Benefit Management. **Minimum Requirements**: - Previous exposure in a Managed Healthcare Call Centre - 5 - 10 years Pre-Auth experience - Previous exposure in Renal Dialysis, Oncology and/or...


  • Centurion, South Africa Network Recruitment (South Africa) Full time

    A top JSE-listed financial services provider that has traded in the industry for well over 2 decades is actively looking for a **Group Internal Auditor**. **A qualified professional that will be fulfilling aspects pf governance, financial and operational audits within the affluent concern. The distinguished company operates on a high reward scale, and...

  • Consultant

    7 months ago


    Centurion, South Africa Novasyte Full time

    P Purpose: - Provides high quality, on-time input to client projects in the life sciences field. Assignments range in complexity from primary market research, basic analysis and problem solving. Will serve as project leader for small teams or work streams. - Principal Accountabilities: - Assists with the review and analysis of client requirements or...


  • Centurion, South Africa Labcorp Full time

    **I. Job Summary**: Data Management leadership on studies and take responsibility for the development of the project documentation, system set-up, data entry and data validation procedures and processes assigned to more junior staff. Assume responsibility for all DM activities (from study start-up to database lock) according to client quality expectations,...

  • Contract Consultant

    6 months ago


    Centurion, South Africa StoneTurn Full time

    Do you want to work for a fast-paced, rapidly growing firm that values culture, work-life balance and reputation above all? If so, StoneTurn could be the right fit for you. StoneTurn, a global advisory firm, assists companies, their counsel and government agencies on regulatory, risk and compliance issues, investigations and business disputes. We serve our...


  • Centurion, South Africa Novasyte Full time

    PROFILE Provide insight which is exercisable across the large part of the organization or by managing a team of managers by influencing outcomes. Oversee & coordinate assigned QA program in support of customer accounts, functional accounts, audit and inspection program, or QA quality management system at a regional and/or global levels. RESPONSABILITIES-...

  • Senior Consultant: Mc

    7 months ago


    Centurion, South Africa Novasyte Full time

    IQVIA South Africa has a great opportunity for a Senior MC Consultant position in our Commercial Solutions team based in Centurion. Responsible for the on-time completion of projects or components of large, complex projects for clients in the life sciences field. Identifies and elevates potential new business opportunities and assists in the sales...

  • Claims Auditor

    1 week ago


    Centurion, South Africa Land Bank Careers Full time

    **Job Advert Summary**: To conduct regular audits which includes planning, implementation and reporting on audits for the various product lines as well administering the life insurance claims which includes, registering, assessing, negotiating and settlement of claims within LBIC and LBLIC.** Key Performance Areas**: 1. Claims Auditing (LBIC and LBLIC) -...

  • Internal Auditor

    6 hours ago


    Centurion, South Africa Land Bank Careers Full time

    **Job Advert Summary**: The Land and Agricultural Development Bank of South Africa (Land Bank) is South Africa’s only specialist agricultural bank established in 1912, the bank’s sole objective is to serve South African commercial and emerging farmers and bring specially designed financial services within their reach. These services enable farmers to...