Current Opportunities at Rand Mutual - RMA

THE JOB AT A GLANCE

• As a Clinical Claims Adjudicator, you will be reporting to the Clinical Claims Adjudicator Team Leader, you will be responsible for effective and efficient adjudication of COIDA and Non-COID (diseases and accidents) i.e. ICD10 codes, Authorisation of treatment, TTD (Temporal Total Disability), claims estimates, Management of Claims MMI (Maximum Medical Improvement), PD (Percentage Disability) calculations and recommend Whole Person Impairment percentage, etc.

WHAT WILL YOU DO?

Claims processing and adjudication

• Medical Management of claims aligned to treatment protocols and COIDA limits and generate Authorisation of treatment plans
• Manage costs associated with the treatment authorization and claims Estimates
• Review and update ICD 10 codes based on First/Progress/Final Medical Reports/Investigation Results
• Review and update claims close to exceeding their Maximum Medical Improvement (MMI)
• Case manage claims with estimated PD of 10% and above to ensure correct liability decisions are made
• Manage, review and adjudicate all claims related to occupational diseases
• Referral of complex cases to the medical department for opinion and action accordingly.
• Contribute and make input on claims complaints.
• Mentor junior CCA staff on claims management.

Whole Person Impairment assessment

• Identify Calculate the Whole Person Impairment rate based on the American Medical Association (AMA) guidelines and the applicable COIDA Instructions
• Review claims and recommend for TTD Payment, Lump Sum payment or Pension

Attend to queries related to claims under management

• Provide Customer Services aligned to TCF (Treating Customer Fairly)
• Assist with queries related to cases and claims under their control and escalate where needed
• Engage and/or provide training to relevant stakeholders

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 7: Bachelor of Occupational Therapy or Physiotherapy
• 3 to 5 years clinical experience.
• 3 to 5 years’ insurance/medical aid claims environment experience
• Group Life Insurance experience advantageous
• COIDA Experience
• Medical/Financial services
• Insurance sector experience
• RE5 Certificate
• ICD10 coding
• Physiotherapy/Occupational Therapist/Occupational Nurse or Clinical Associate qualification

Closing date:  22 June 2023

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THE JOB AT A GLANCE

• As the Claims Assessor, you will be reporting to the Team Leader: Claims Assessor. You will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out by Rand Mutual Assurance.

WHAT WILL YOU DO?

Claims Adjudication:

• Verify claims captured for correctness and compliance
• Capture / accept additional information on claims i.e. medical reports
• Ensure all documents required to process a claim are indexed and filed into the system
• Add meaningful and accurate notes to ensure complete synopsis of claim on the system
• Update requirements on claims and ensure they are always accurate and up to date.

Claims Management:

• Manage claims in line with individual targets
• Review of claims in line with process, authority limits and within agreed timelines
• Escalate where required within authority limits
• Management of medical reports for claims with Permanent Disability
• Communicate claims process to both the employer and employee as set out in the claim’s management processes
• Timeous management of workflows and notifications.

Adjudicate and process payments for claims:

• Adjudication and processing of TTD benefits including approval within authority limits
• Adjudicating and processing payment of sundry invoices within authority limits
• Process Permanent Disability claims.

Customer Service:

• Regularly communicate and liaise verbally and in writing with customers/suppliers/visitors/enquirers and relevant staff
• Interpret and respond clearly and effectively to spoken requests over the phone or in person, and to verbal or written instructions
• Manage walk-in queries as and when required in line with the RMA Service Catalogue
• Handle customer inquiries both telephonically and by email
• Research required information using available resources
• Provide customers with accurate product and service information in an efficient manner
• Update existing customer personal information on the system
• Deal with all customers in a professional and empathetic manner.

WHAT YOU'LL BRING TO THE TABLE?

• FAIS Regulatory Examination (RE5)
• NQF Level 5 Higher Certificate in a FAIS Recognised Qualification
• A medical qualification would be advantageous
• 3 to 5 years claims related experience
• Intimate knowledge of the COID Act
• Good Administrative skills
• Advanced Excel Skills
• Knowledge of Claims processing, approval
• Insurance and/or Medical Aid experience
• Deadline driven

Closing date: 18 May 2023

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THE JOB AT A GLANCE

• As an Administrative Assistant- Medical, you will be responsible for effectively and efficiently capturing data, imaging, indexing, providing administrative support and attend to client/customer queries (no advice to be given).

WHAT WILL YOU DO?

• Data capturing/entry (including telephonic reporting)
• Capture information on calls received (Contact Centre), and where required maintain detailed and accurate records
• Perform reception duties in an efficient, professional and courteous manner
• Communicate and liaise verbally and in writing with customers/suppliers/ and visitors (no advice provided)
• File data and perform other routine clerical tasks as assigned
• Receive, sort, barcode, scan, batch, index and distribute incoming mail in accordance with standard operating procedures/Technical Committee instructions/and Service Level Agreements
• Compiling records of office activities
• Update existing customer personal information
• Assist clients to submit claim claims electronically and complete relevant application forms (no advice only on procedure)
• Complete ad hoc duties as requested and responded to in the stipulated time frame

WHAT YOU'LL BRING TO THE TABLE?

• Grade 12 (Required)
• COIDA in Practice or Insurance Qualification an advantage
• Diploma in Office Administration/Secretarial (Added advantage)
• At least 1 year industry related experience
• Knowledge of administrative and clerical procedures
• Computer literate – Intermediate MS Office Suite
• Knowledge of customer service principles and practices
• Data-entry experience and good typing skills

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THE JOB AT A GLANCE

• As the Programme Manager, you will be responsible for the coordination and management of programmes and change initiatives to achieve beneficial change. You must have expertise in additional services required by programmes, such as portfolio management, supporting change management, benefits realisation, and project interfaces. You will be required to support the Head of PMO in the establishment of the PPM practices to improve the level of maturity.

WHAT WILL YOU DO?

• Successfully planning and designing the programme and proactively monitoring its progress, resolving issues and initiating appropriate corrective action
• Defining the programme's governance arrangements
• Ensuring effective quality assurance and the overall integrity of the programme - focusing inwardly on the internal consistency of the programme, and outwardly on its coherence with infrastructure planning, interfaces with other programmes and corporate, technical and specialist standards
• Managing the programme's budget on behalf of the Sponsor, monitoring expenditure and costs against delivered and realised benefits as the programme progresses
• Facilitating the appointment of individuals to project teams
• Ensuring the delivery of new products or services from projects is to the appropriate level of quality, on time and within budget, in accordance with the programme plan and programme governance arrangements
• Ensuring there is allocation of common resources and skills within the programme's individual projects
• Managing third party (internal teams and external suppliers) contributions to the programme
• Managing communications with all stakeholders
• Managing both the dependencies and the interfaces between projects
• Managing risks to the programme's successful outcome
• Working with the business change manager or equivalent on the transition to the new business as usual position
• Initiating extra activities and other management interventions wherever gaps in the programme are identified or issues arise
• Reporting the progress of the programme at regular intervals to the required and various governance forums
• Support the Head of PMO in the establishment of PPM practices to improve the PMO’s maturity, including portfolio, programme and project management processes, tools and techniques
• Provide guidance, in the form of coaching and mentoring, to project managers and other project team members where necessary

WHAT YOU'LL BRING TO THE TABLE?

• NQF Level 7: Bachelor’s degree in BSc or BCom
• Qualification in project management or equivalent is a must
• Post graduate qualification is advantageous
• Programme Management certification advantageous
• Experience with various project and programme management frameworks, e.g. PMBOK, PRINCE, Agile, SAFe, etc.
• At least 8 years or more Programme and Project Management experience
• Direct work experience in programme management capacity
• Sound experience planning, managing, and delivering complex large programmes
• Solid experience in establishing project management offices and the associated processes, tools, and techniques
• Solid experience mentoring and coaching project teams
• Knowledge of both theoretical and practical aspects of project and programme management
• Knowledge of project and programme management techniques and tools
• Understanding of programme support functions, including portfolio management, change management, financial management, contract management, procurement
• Business acumen and understanding of operations in the financial services
• Strategic thinking and ability to translate strategy to operational plans
• Experience with managing multiple projects | programme simultaneously
• Excellent communication: verbal, written and presentation skills
• Ability to effectively deal with all stakeholders including junior, senior and executive level roles
• Ability to manage large delivery teams consisting of various subject matter experts
• Ability to translate and simplify concepts to practical delivery plans
• Follow through on delivery – from planning, to execution, to close-out and post implementation monitoring