Website Road Accident Fund
The Road Accident Fund is a state insurer established by statute, it provides insurance cover to all drivers of motor vehicles in South Africa in respect of liability incurred or damage caused as a result of a traffic collision. Liability incurred in relation to property damage (such as damage to ve… read morehicles, buildings, vehicle contents) is excluded from cover.
NB: is a Three (3) years Fixed-Term Contract position
Purpose of the job: The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.
Key Performance Areas
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 aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tarrifs.
Escalation of complex cases for multi disciplinary review and adjudication.
Participate in the consultations process on the implementation of medical claims processes.
Exception Handling.
Ensure the implementation and maintenance of a formal exception handling process within the medical management.
Maintain the documentation and regular updating of the exception handling process.
Maintain the implementation an unusual occurrence procedures.
Reporting.
Track and report against set objectives and targets.
Report on emerging risks.
Provide ad hoc reports on process improvement initiatives.
Produce documents, briefing papers, reports and presentations.
Stakeholder Management
Deal with/and respond to correspondence.
Maintain healthy relationships with all stakeholders.
Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
Follow up and feedback to all stakeholders to keep them updated on the status of a query.
Respond to queries within the predefined turnaround times.
Qualifications
Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
Registration with HPCSA/SANCA.
Experience
Relevant 3 years’ experience in a Medical related environment.
Technical and behavioral competencies required
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
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Apply via company website ( http://www.raf.co.za ) or