Medical Management Consultant - Claims & Pre-Authorization

Tafadzwa; Pretoria; Presencial; ZAR 420.000 - 520.000; Jornada completa

Descripción de la vacante

Tafadzwa is recruiting a Consultant: Medical Management responsible for implementing medical management activities, exception handling and providing administrative support in claims processing. The role involves medical assessments, injury reports, claims pre-authorization, and multidisciplinary case reviews.

You will maintain exception handling processes, track performance against targets, and prepare reports.

Formación

• Bachelor’s Degree/Advanced Diploma in Health Sciences or a related medical qualification.
• Registration with HPCSA or SANCA (if applicable).
• Minimum 3 years’ experience in a medical-related environment.

Responsabilidades

• Implement medical management activities in claims processes.
• Conduct medical assessments and compile injury assessment reports.
• Review treatment, level of care, length of stay and quality of care for submitted claims.
• Pre-authorise submitted claims according to clinical guidelines and tariffs.
• Escalate complex cases for multidisciplinary review and adjudication.
• Support the consultations process on medical claims procedures.
• Maintain and update formal exception handling processes.
• Track and report against set objectives and provide ad hoc process improvement reports.
• Engage with stakeholders and respond to queries within defined turnaround times.

Conocimientos

Medical management

Claims processing

Stakeholder management

Educación

Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification

Registration with HPCSA/SANCA

Descripción del empleo

Tafadzwa is recruiting a Consultant: Medical Management responsible for implementing medical management activities, exception handling and providing administrative support in claims processing. The role involves medical assessments, injury reports, claims pre-authorization, and multidisciplinary case reviews.

You will maintain exception handling processes, track performance against targets, and prepare reports.