Case / Claim Manager

Manage calls from Hospital Case Managers regarding authorisations for procedures in hospital, **trauma, casualty**, GP or dental rooms - Case management from issuing a guarantee of payment to final discharge and follow up treatment - Manage clinical risk to decrease claims over utilisation - Pre-authorisation of GP visits per benefit option rules - Classify...

1. **Qualifications**: - Matric - Registered Nursing diploma - Valid membership of SANC - Claims and Forensic Risk management certification - Registration with the Association of Certified Fraud Examiners (ACFE SA) - A completed RE5 certificate essential 2. **Skills and Experience**: - At least 2-3 years experience in a similar role. - MIP Application...

Job Introduction The Member Cases and Claims Division is at the forefront of protecting the careers, reputation and financial risk of our members worldwide. The purpose of the role is to support the provision of excellent case handling services for members which is trusted and valued and provides fair treatment and outcomes. The role will do this by managing...

Job title : Director: Case Management (Lower Courts)Job Location : Gauteng, JohannesburgDeadline : April 10, 2025Quick Recommended LinksJobs by Location Job by industries REQUIREMENTS :Applicants must be in possession of a three-year Bachelor's Degree or Advanced Diploma (NQF Level 7) in Management, Social Sciences, Public Administration, Public...

**Job Advert Summary**: MHR is urgently looking for a **Registered Nurse Case Manager** with **Disease Management experience.** This is a **permanent opportunity** at a well-known medical aid** **in** Randburg** in** Johannesburg**. **Minimum Requirements**: - 5 years of case management and disease management experience - Minimum of 3 years’ experience...

**Our client, a well-established legal and insurance company is currently looking to employ a Claims Manager.** **Main purpose of the position**: - Manage all incoming legal, health and funeral claims in accordance with internal legislative requirements in the spirit of Treating Customers Fairly**.** **Qualifications**: - Must be a FAIS Authorised...

Requirements:Nursing qualification (Registered or Enrolled Nurse).3 to 5 years of nursing experience, with back-office or case management experience preferred.Knowledge of medical scheme regulations, ICD-10 coding, tariffs, and case management protocols.Strong attention to detail, communication, and administrative skills.Computer literacy, including...

**Job Advert Summary**: A leadership role in the Life Operations team reporting to the Claims Manager. This role is responsible for managing a team responsible for assessing Sickness, Permanent Incapacity and Disability Claims as well as Case/Claims Management of ongoing claims. Ensure best practice and supporting the company in meeting its...

**Job Advert Summary**: Are you in the market for temporary case manager opportunities at a well-known and dynamic agency? MHR is urgently looking for experienced **Hospital Case Managers** to work **part-time shifts** at a private hospital in **Sandton area** in **Johannesburg**. **Minimum Requirements**: **Requirements**: - Professional Nurse with at...

**Claims Specialist** An insurance company has a new position available for a Claims Specialist: Liability who will be based in Johannesburg - Illovo. **Minimum Requirements** - Experience 2 years in Liability / PI claims (handling at an insurer or litigation at an attorney firm) - Matric - Legal qualification required **Duties** Claims Practice...

What will you do? This career opportunity is available at SHA Risk Specialists, a division of Santam for a Claims Specialist: Casualty Claims, who will be based in Johannesburg, Illovo. What will make you successful in this role? Claims Practice Management Attend and manage all aspects related to a portfolio of specialist claims such as claims...

Claims Consultant Career Level 3 **Company** Munich Re **Location** Johannesburg, South Africa **Your Business Unit**: Our Life Claims Management team mitigates risk at claim stage. We collaborate across the various Life business units, including Underwriting, Product & Pricing, Chief Medical Office and Marketing. **Your Team**: Our Life Claims...

**Location: Paarl **- Western Cape **Reporting to**: Group Operations Manager Our Client provides direct niche finance solutions to the legal industry. We provide tailor made funding and finance solutions to attorneys, suppliers of medical services, suppliers of medico-legal reports, as well as victims in the field of personal injury law. **What Will You...

Bring your possibility to life! Define your career with us - With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.Job Summary To...

**Job Information** - Location- Johannesburg- Salary- R400k-R300k- Job Type- Permanent- Education- Degree/Diploma in Nursing- Experience- +2 years’ experience in case management- - pharmacy.jobs(at)staffingprojects.co.za- Fax- 0866023398This just in! A vacancy for a case manager at a private hospital in Johannesburg is currently...

Opportunity in a premier commercial risk insurance company awaits you, to handle complex claims with expertise. You will be responsible for promptly handling marine claims, resolving all related enquiries, and developing a claims case strategy to ensure that appropriate reserves are assigned, investigations conducted, and appropriate suppliers engaged. You...

Role Title: Case Manager Role Summary: Are you a healthcare professional looking to make a significant impact in patient care and financial risk management? If so, we have an exciting opportunity for you to join the team of a private hospital based in Gauteng as a Case Manager. In this role, you will leverage your clinical knowledge and expertise to ensure...

The Marine Claims Specialist’s role is to, with limited supervision, manage the non-standard complex claims (high severity/complexity) in the most effective, efficient way whilst delivering a customer centric claims service in a manner which supports Bryte Basics. Key Tasks & Accountabilities - Promptly handle marine claims and take responsibility to...

**Job Summary**: To plan, coordinate and execute case management work at hospital level. The incumbent utilities clinical knowledge to minimise financial risk and ensure accurate billing through comprehensive accurate coding of patient care. **Minimum Qualifications and Experience*** - Nursing degree / diploma. - Current registration with South African...

**Purpose of this role**: The purpose of this role is responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims. Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to make appropriate and...