Division: Claims
Ref No: 6084
Placement: East London, Eastern Cape, ZA
Employment Type: Fixed Term Contract
Disability (EE targeted part): Yes
Grade: 11
No. of Posts: x24
Remuneration: R 501,775.00
Due Date: 25 Sep 2025
The Road Accident Fund’s charge is to give applicable cover to all road druggies within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to laboriously promote safe use of our roads.
Note: These are 36- month, fixed- term contract positions
Purpose of the job The Adviser Medical Management is responsible for enforcing the medical operation conditioning, medical exception running and furnishing administration support in claims processing.
Crucial Performance Areas
Medical Operation
- Conduct medical assessment and collect injury assessment reports.
- Conduct assessments and bill reviews on submitted claims, fastening on the applicable position of care, the length of stay, and quality of care.
- Incorporate tariffs, cost savings action recording, and treatment protocol to insure that all service providers cleave to the rules, and the tariff as guided by the RAF and/ or any that’s considered reasonable.
- Preauthorize submitted claims aligned to RAF clinical guidelines including the RAF formulary, treatment protocols and affiliated tariffs.
- Escalation of complex cases for multi-disciplinary review and adjudication.
- Share in the consultations process on the perpetration of medical claims processes.
Exception Handling.
- Insure the perpetration and conservation of a formal exception running process within the medical operation.
- Maintain the attestation and regular updating of the exception running process.
- Maintain the perpetration of an unusual circumstance procedure.
Reporting
- Track and report against set objects and targets.
- Report on arising pitfalls.
- Give ad hoc reports on process enhancement enterprise.
- Produce documents, briefing papers, reports, and donations.
Stakeholder Operation
- Deal with and respond to correspondence.
- Maintain healthy connections with all stakeholders.
- Follow up and resolve all queries and make recommendations on which corrective conduct are applicable.
- Follow up and feedback to all stakeholders to keep them streamlined on the status of a query.
- Respond to queries within the predefined reversal times.
Qualifications
- Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
- Registration with HPCSA/SANCA
Experience
- Applicable 3 times’ experience in a Medical affiliated terrain
Specialized and behavioral capabilities needed:
- Claims operation process/ processes and systems.
- Medical product operation
- Medical bill reviewing
- Medical case operation
- Complex problem identification, working and decision making
- Client value proposition
- Strong clinical logical capabilities
- Knowledge of motor vehicle accident legislation
- Planning, Organising and Coordinating.
- Particular Mastery.
- Judgement and Decision Making.
- Ethics and Values.
- Client Service Orientation.
NB: “RAF offers Total Employment Cost packages with no fresh benefactions from the Employer, successful campaigners are needed to structure their packages in a manner that will suit their requirements.”
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Aspirants who haven’t entered any correspondence from us within six weeks from the ending date can consider themselves unprofitable
Security Vetting shall be conducted on all prospective workers
It’s the aspirants’ responsibility to have foreign qualification estimated by the South African Qualification Authority (SAQA) and to give evidence of similar evaluation.
COMPLETE YOUR ONLINE APPLICATION HERE
