Manager : Medical Management

Road Accident Fund; Cape Town; On-site; ZAR 700,000 - 1,000,000; Full time

Job summary

A leading company in the insurance sector is seeking to hire a Manager for their Medical Management capability. The role involves overseeing medical claims, managing assessment processes, reporting, and leading a team. Candidates should possess a relevant degree and extensive experience in Medical Management, especially in a supervisory capacity. This position provides an exciting opportunity to contribute to vital operations and improve service delivery standards within the organization.

Qualifications

• 6-8 years of experience in a Medical Management role.
• 2 years in a management or supervisory level.

Responsibilities

• Manage medical assessments and insurance claims.
• Prepare and submit regulatory reports.
• Lead a high-performance team.

Skills

Communication

Analytical capabilities

Problem solving

Change management

Conflict management

Education

Bachelor’s Degree / Advanced Diploma in Health sciences

Postgraduate in Health Sciences or Medical related qualification

Registration with HPCSA / SANCA

Tools

Claims management processes and systems

Medical case management

Job description

Purpose of the Job : To Manage the medical management capability in supporting the claims operations.

Key Performance Areas

Policy review and implementation

• Contribute to the development and implementation of claims medical operations policy, procedures and processes.
• Keep up to date with effective claims operations policy and practice execution strategies

Medical management

• Manage medical assessments including injury assessments of past and future medical care, preauthorization and clinical coding
• Manage the assessment of the seriousness of medical injuries and determination of future care.
• Manage the implementation of the tariff, 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.
• Review assessment reports and provide recommendations.
• Develop tracking methods to report analysis results in business case scenarios
• Manage the development and maintenance of formal exception handling process within the medical management unit
• Manage the documentation and regular updating of the exception handling process
• Management of supporting policies and procedures in line with managing exception handling with division.

Reporting

• Prepare and submit regulation reports as and when required to provide progress updates and / or inform management decisions.
• Develop reports / policies / procedures and guide the process through the alignment of the documents to the overall RAF’s strategy.
• Develop functional reporting systems, for management, projects or performance reporting
• Prepare proposals, briefings, presentations, reports, and other documentation and provide management information both verbally and in report format.
• Facilitate and manage communication with relevant internal and external stakeholders proactively and progressively manage the relationships.
• Manage relationships with vendors, service providers or procurement teams and ensure that all relevant procured items are invoiced and paid on time.
• Communicate with all levels of stakeholder contact.
• Represent the Fund in relevant external activities and events.

People Management

• Ensure the sourcing, development and retention of a high-performance team.
• Manage the recruitment of the operational workforce in line with employment equity targets
• Manage staff in the department to ensure that they achieve their objectives in line with the strategic objectives of the RAF
• Manage the implementation of human capital processes and procedures to control / regulate workplace conflict and / or institute corrective measures and consultation processes to address deviations from standards
• Allocate, direct, motivate and evaluate subordinates to help them achieve their individual goals.

Qualifications and Experience

• Bachelor’s Degree / Advanced Diploma in Health sciences or Medical related qualification.
• Postgraduate in Health Sciences or Medical related qualification will be an added advantage
• Registration with HPCSA / SANCA
• Relevant 6-8 years’ experience in a Medical Management related environment of which 2 years must have been on a management / supervisory level / area of expertise.

Behavioral

• Resilience
• Communication
• Working with people
• Network and Alliances
• Planning, Organizing and Coordinating
• Personal mastery
• Judgement and decision making
• Ethics and values
• Client services orientation

Managerial

• Change management
• Coaching and mentoring
• Conflict management
• Critical and innovative thinking
• Direction setting
• Facilitation and presentation skills
• Policy conceptualization and formulation
• Stakeholder development and relations
• Reporting

Technical

• Claims management process / processes and systems
• Medical management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Good financial management skills
• Strong analytical capabilities
• Knowledge of Motor Vehicle Accident legislation
• PFMA knowledge

Road Accident Fund Values

• Integrity
• Compassion
• Accountability
• Respect
• Empathy

NB : “RAF offers Total Employment Cost packages with no additional contributions from the Employer, successful candidates are required to structure their packages in a manner that will suit their needs”

Purpose of the Job : To Manage the medical management capability in supporting the claims operations.

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