Medical Management Expert

4 days ago


Cape Town, Western Cape, South Africa Road Accident Fund Full time
Job Title: Medical Management Expert - RAF

We are seeking a highly skilled and experienced medical management expert to join our team at the Road Accident Fund (RAF). The ideal candidate will possess excellent clinical knowledge, analytical skills, and exceptional communication abilities.

Key Responsibilities:
  • Conduct thorough medical assessments and compile detailed reports on injury claims, ensuring adherence to RAF guidelines and protocols.
  • Analyze submitted claims, focusing on the appropriate level of care, length of stay, and quality of care, and make recommendations for approval or rejection.
  • Develop and maintain relationships with service providers, ensuring they adhere to RAF tariffs and treatment protocols.
  • Escalate complex cases for multi-disciplinary review and adjudication, providing clear explanations and justifications.
  • Participate in the development and implementation of medical claims processes, contributing to the improvement of claims handling efficiency and effectiveness.
Requirements:
  • Bachelor's degree/Advanced Diploma in Health Sciences/Medical related qualification.
  • Registration with HPCSA/SANCA.
  • At least 3 years' experience in a medical-related environment, preferably in claims assessment and management.
Benefits:
  • A competitive salary range of R750,000 - R900,000 per annum, depending on experience.
  • Ongoing professional development opportunities.
  • A dynamic and supportive work environment.


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