Consultant : Medical Management X2

Road Accident Fund; Centurion; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A government agency for road safety seeks a Consultant in Medical Management to conduct assessments and manage medical claims. The ideal candidate will have a Bachelor's degree in Health Sciences and a minimum of three years' experience. Key responsibilities include medical assessments, claims pre-authorisation, and stakeholder management.

Qualifications

• 3 years experience in a Medical related environment required.

Responsibilities

• Conduct medical assessments and compile injury assessment reports.
• Ensure service providers adhere to the tariff and guidelines.
• Pre-authorise submitted claims aligned to clinical guidelines.
• Deal with correspondence and maintain healthy relationships with stakeholders.

Skills

Claims management process

Medical product management

Medical bill reviewing

Medical case management

Education

Bachelor’s Degree / Advanced Diploma in Health Sciences

Registration with HPCSA / SANCA

Job description

Overview

Job title: Consultant : Medical Management X2

Job Location: Gauteng, Centurion

Deadline: October 11, 2025

Note: THIS IS A THREE (3) YEAR FIXED TERM CONTRACT

Key Responsibilities

• Medical Management: Conduct medical assessment and compile injury assessment reports.
• Medical Management: Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay and quality of care.
• Medical Management: 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.
• Medical Management: Pre-authorise submitted claims aligned to RAF clinical guidelines including the RAF formulary treatment protocols and related tariffs.
• Medical Management: Escalation of complex cases for multi-disciplinary review and adjudication.
• Medical Management: Participate in the consultations process on the implementation of medical claims processes.
• Exception Handling: Ensure the implementation and maintenance of a formal exception handling process within the medical management.
• Exception Handling: Maintain the documentation and regular updating of the exception handling process.
• Exception Handling: Maintain the implementation of unusual occurrence procedures.
• Reporting: Track and report against set objectives and targets.
• Reporting: Report on emerging risks.
• Reporting: Provide ad-hoc reports on process improvement initiatives.
• Reporting: Produce documents, briefing papers, reports and presentations.
• Stakeholder Management: Deal with / and respond to correspondence.
• Stakeholder Management: Maintain healthy relationships with all stakeholders.
• Stakeholder Management: Follow up and make recommendations on corrective actions as appropriate.
• Stakeholder Management: Follow up and provide feedback to all stakeholders to keep them updated on the status of a query.
• Stakeholder Management: Respond to queries within the predefined turnaround times.

Qualifications and Experience

• Bachelor’s Degree / Advanced Diploma in Health Sciences / Medical related qualification.
• Registration with HPCSA / SANCA.
• Relevant 3 years’ experience in a Medical related environment.

Technical Competencies Required

• Claims management process / processes and systems.
• Medical product management.
• Medical bill reviewing
• Medical case management

Behavioural Competencies Required

• Planning, Organising and Coordinating
• Personal mastery
• Judgment and decision making
• Ethics and Values
• Client Service Orientation