Contract Consultant Medical Management - 3 Year Co

Description:

A financial services business is seeking to appoint a Consultant Medical Management - 3 Year Contract. The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing. Qualifications: Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification. Registration with HPCSA/SANCA Medical management 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. Incorporate tariffs, cost savings initiative recording, and treatment protocol to ensure that all service providers adhere to the rules, and the tariff as guided by the RAF and / or any that is considered reasonable. Pre-authorise submitted claims Escalation of complex cases for multi-disciplinary review and adjudication. Participate in the consultations process on the implementation of medical claims processes. Experience: Relevant 3 years’ experience in a Medical related environment 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 Strong clinical analytical capabilities Knowledge of motor vehicle accident legislation Planning, Organising and Coordinating. Personal Mastery. Judgement and Decision Making. Ethics and Values. Client Service Orientation. Please note that if you have not received a response within 14 days of submitting your application that your application was unsuccessful. However, please keep a lookout on our website, www.sixsense.co.za for available positions which may be inline with your career aspirations. SECTOR: Insurance


Job Reference #: JHB001241/MS