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Consultant Medical Management - 3 year Fixed Term Contract 2
A well-established financial services business is seeking to appoint a Consultant Medical Management on a 3 year Fixed Term Contract
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.
Qualifications and Experience:
Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
Registration with HPCSA/SANCA
Relevant 3 years’ experience in a Medical related environment
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.
Escalation of complex cases for multi-disciplinary review and adjudication.
Participate in the consultations process on the implementation of medical claims processes.
Technical Competencies:
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
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