Medical Adjudicator (Professional Nurse) - Mmabatho at The Department of Employment and Labour

REQUIREMENTS:

• Four (4) years nursing degree/three years’ diploma. Post Graduate Diploma in Occupational Health/Theatre Technique/Critical Care will be an advantage.
• Experience in trauma/emergency/internal medicine/general surgery/orthopaedics/theatre at the regional public or private hospital is required.
• Experience in medical claims processing/insurance environment will be an added advantage.
• Registration with the South African Nursing Council.
• Grade 1: 2 to 9 years’ experience gained after registration.
• Grade 2: 10-19 years’ experience gained after registration.
• Grade 3: 20 years’ experience gained after registration.
• Knowledge:   DoL and Compensation Fund objectives and business functions, Compensation Fund Services, Directorate or sub-directorate goals and performance requirements, nursing legislations and or related legal as well as ethical nursing practices,
• Compensation Fund policies, procedures and processes, Stakeholders and customers, Customer Service (Batho Pele Principles), COIDA tariffs, Technical knowledge, PFMA and National Treasury Regulations, Public Service Act. Skills: Required Technical Proficiency, Business writing, Required IT skills, Data capturing, Data and records management, Telephone Skills and Etiquette.

DUTIES:    

• Provide medical advice and recommendation in the acceptations of liability.
• Recommend the approval of medical accounts.
• Provide medical advice on the processing of occupational injury claims.
• Determine PD (Permanent Disability) and TTD (Total Temporary Disability).
• Assess medical accounts on occupational injury claims and OD medical accounts.