Pensions Medical Case Auditor at Rand Mutual - RMA

THE JOB AT A GLANCE

As the Pensions Medical Case Auditor (PMCA), you will be responsible for effectively and efficiently rendering medical support to internal and external stakeholders.

WHAT WILL YOU DO?

• Monitoring of Hospital Admissions weekly and liaison with Case Managers.
• Give feedback to Case Managers and other Colleagues of Pensioners admitted in Hospitals and include for hospital utilisation management.
• Authorization of Pensioners Hospital admissions, Chronic Medications and Sundries, prosthetic repairs and replacement
• Adjudicate requests for subsequent care and refer to RMA doctor as necessary.
• Assess and adjudicate medical service provider reports and advise on invoices submitted and captured when requested.
• Visit medical service providers and hospitals to address Pensioners related issues
• Organize and attend scheduled clinics.
• Organize transport for SCI acute admissions, uro reviews and taxi fares for prosthetic pensioners.
• Visit existing high risk/cost and new DRG 1 pensioners as per PMP schedule.
• Organizing uro reviews and capture the uro report.
• Organize prosthetic review clinic and load report on CC2.
• Assist to obtain death certificate and Notification of Death (if available) for deceased pensioners and autopsy reports if available.
• Assist with medical walk-in office clients.
• Capture Medical Reports via scanning in respect of pensioners, chronic medication, and subsequent care and specific medical reports requested.
• Assist with education of pensioners on entitlements.
• Updating DOCR with hospital pensioner admissions and discharges for DRG 1 to 3.
• Weekly/Monthly report of Pensioner URO reviews, home visits and prosthetic reviews and other interventions.
• Manage visa and passport expiry documents of SCI pensioners in Hospital.
• Managing and control of medical expenses as per yearly plan
• Follow up, from RMA system generated reports, high cost claims based on type of injury and estimated costs.

WHAT YOU'LL BRING TO THE TABLE?

• Nursing diploma /degree
• 3  years nursing experience as professional nurse
• Valid Driver’s License
• Registration with Nursing Council or relevant Health Professional Council
• Building Customer Loyalty
• Contributing to Team Success
• Managing Work (includes Time Management)
• Stress Tolerance
• Decision Making
• Confidentiality
• Credibility
• Friendly
• Initiative
• Integrity

WHAT WILL YOU GET IN RETURN?

This is an exciting opportunity within the Rand Mutual Assurance team, offering exposure to an interesting combination of technical and business issues. This is a great time to join RMA as we look to grow the Life business and develop our actuarial team.