Road Accident Fund (RAF)
Consultant: Medical Management X20
About Road Accident Fund (RAF)
The Road Accident Fund’s mission is to provide appropriate cover to all road users within the borders of South Africa. We are committed to rehabilitating and compensating persons injured as a result of motor vehicle accidents in a timely and caring manner, while actively promoting safe use of our roads.
Purpose of the Job
The Consultant: Medical Management is responsible for implementing medical management activities, handling medical exceptions, and providing administrative support in claims processing. This role requires a healthcare professional who can ensure appropriate medical care and cost-effective treatment for road accident victims.
Key Performance Areas
Medical Management
- Conduct medical assessments and compile comprehensive injury assessment reports
- Perform assessments and bill reviews on submitted claims, focusing on appropriate level of care, length of stay, and quality of care
- Incorporate tariffs, cost savings initiatives, and treatment protocols to ensure service providers adhere to RAF guidelines
- Pre-authorize submitted claims in alignment with RAF clinical guidelines, including the RAF formulary, treatment protocols, and related tariffs
- Escalate complex cases for multi-disciplinary review and adjudication
- Participate in consultation processes for implementing medical claims procedures
Exception Handling
- Implement and maintain a formal exception handling process within medical management
- Maintain documentation and regularly update the exception handling process
- Implement unusual occurrence procedures as required
Reporting
- Track and report against set objectives and targets
- Report on emerging risks in medical management processes
- Provide ad hoc reports on process improvement initiatives
- Produce documents, briefing papers, reports, and presentations
Stakeholder Management
- Handle and respond to correspondence promptly
- Maintain healthy relationships with all stakeholders
- Follow up and resolve all queries, making recommendations for corrective actions
- Provide regular feedback to stakeholders regarding query status
- Respond to queries within predefined turnaround times
Qualifications and Experience
Required Qualifications
- Bachelor’s Degree or Advanced Diploma in Health Sciences/Medical related qualification
- Registration with HPCSA/SANCA
Experience Requirements
- Minimum 3 years’ experience in a medical-related environment
Required Competencies
Behavioral Competencies
- Strong planning, organization, and coordination skills
- Personal mastery and professional development
- Excellent judgement and decision-making capabilities
- High ethical standards and values
- Strong client service orientation
Technical Competencies
- Knowledge of claims management processes and systems
- Medical product management expertise
- Medical bill reviewing skills
- Medical case management experience
- Complex problem identification, solving and decision making
- Customer value proposition understanding
- Strong clinical analytical capabilities
- Knowledge of motor vehicle accident legislation
Application Information
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Security vetting will be conducted on all prospective employees.
It is the applicant’s responsibility to have foreign qualifications evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful.
How to Apply
To apply for this position, please visit the RAF careers portal:
https://careers.raf.co.za/job/Durban-Consultant-Medical-Management-X20-Kwaz/1326540755/?rb=LinkedIn
Note: This is a fixed-term contract position for 3 years based in Durban, KwaZulu-Natal. The successful candidate will join a team dedicated to providing quality medical management services to road accident victims.