X8 Medical Management Consultant Vacancies at the Road Accident Fund (RAF)

Deadline: 28th January 2025

The Road Accident Fund (RAF) is recruiting qualified candidates for 8 Medical Management Consultant positions. Applications close on 28 January 2025.

Job Details

• Position: Medical Management Consultant (8 Posts)
• Division: Claims
• Reference No: 5275
• Location: Johannesburg, Gauteng
• Employment Type: Fixed-Term Contract (3 years)
• Salary: R501,775 per annum

Purpose of the Job

The Medical Management Consultant will handle medical management activities, manage medical exceptions, and provide administrative support in claims processing.

Key Responsibilities

Medical Management

• Conduct medical assessments and prepare injury assessment reports.
• Review medical bills and assess claims to ensure proper care, duration, and quality of care.
• Apply RAF clinical guidelines, including formularies, protocols, and tariffs.
• Pre-authorize claims in line with RAF guidelines.
• Escalate complex cases for multidisciplinary review and decision-making.
• Participate in consultations for implementing medical claims processes.

Exception Handling

• Establish and maintain a formal process for exception handling.
• Update and document exception-handling procedures regularly.
• Implement and manage procedures for unusual occurrences.

Reporting

• Track and report progress against objectives and targets.
• Identify and report emerging risks.
• Create reports on process improvement initiatives.
• Prepare documents, briefing papers, and presentations.

Stakeholder Management

• Respond to correspondence and maintain healthy stakeholder relationships.
• Resolve queries and recommend corrective actions.
• Provide updates on query statuses and respond within predefined timelines.

Qualifications and Experience

Education

• Bachelor’s Degree or Advanced Diploma in Health Sciences or a medical-related field.
• Registration with HPCSA or SANCA.

Experience

• At least 3 years of experience in a medical-related environment.

Required Competencies

• Knowledge of claims management processes.
• Expertise in medical product and case management.
• Experience in reviewing medical bills.
• Strong problem-solving and decision-making skills.
• Understanding of motor vehicle accident legislation.
• Ability to plan, organize, and coordinate.
• Strong clinical analytical skills and client service orientation.

How to Apply

1. Submit Your Application:
   • Access the application portal and apply here.
2. Include the Following Documents:
   • Updated CV.
   • Certified copies of your qualifications.

Closing Date

Applications must be submitted by 28 January 2025.

Take advantage of this opportunity to work with the RAF and contribute to effective medical claims management. Apply today!