The Road Accident Fund (RAF) plays a crucial role in South Africa, helping those who are injured in road accidents receive the rehabilitation and compensation they need. With its focus on road safety, medical care, and financial support, the RAF serves millions of people across the country. One exciting opportunity now available within this impactful organization is the position of Consultant: Medical Management (Reference No: 4880) at the RAF’s Claims division, based in Johannesburg, Gauteng.
This fixed-term role is perfect for professionals with a background in health sciences or medical management who are ready to contribute to the efficient handling of medical claims.
Purpose of the Consultant Role
The Consultant: Medical Management is responsible for overseeing medical management activities, handling medical exceptions, and supporting the claims processing team. This role ensures that the RAF delivers medical care and services according to established protocols and guidelines, and that claimants receive the support they need in a timely manner.
As the RAF’s mission states, the organization is dedicated to providing appropriate cover to all road users within the borders of South Africa, offering rehabilitation and compensation to those injured in road accidents. By playing a critical role in the claims process, the Consultant: Medical Management contributes directly to this mission.
Key Responsibilities
The job requires a combination of medical expertise, administrative skills, and stakeholder management to ensure the smooth processing of claims and the proper assessment of medical needs. Below are some of the major areas of responsibility for this position:
Medical Management
- Medical Assessments: Conducting assessments and compiling injury reports to ensure claimants receive the appropriate level of care.
- Bill Reviews: Assessing submitted medical bills, focusing on cost control, length of stay, quality of care, and adherence to medical tariffs.
- Pre-Authorizations: Approving medical claims that align with the RAF’s clinical guidelines, formularies, treatment protocols, and tariffs.
- Escalation of Complex Cases: Referring complex claims for multidisciplinary review and adjudication.
- Collaboration: Participating in consultations to improve the RAF’s medical claims processes.
Exception Handling
- Process Management: Implementing and maintaining a formal process for handling exceptions in medical management.
- Documentation: Regularly updating and maintaining exception handling documentation.
- Unusual Occurrences: Establishing and maintaining procedures for addressing unusual occurrences within medical claims processing.
Reporting
- Progress Tracking: Regularly tracking and reporting against set objectives and targets in medical claims processing.
- Risk Reporting: Reporting emerging risks within the medical management environment.
- Ad Hoc Reporting: Producing reports, presentations, and briefing documents for management and process improvement.
Stakeholder Management
- Correspondence Handling: Managing and responding to queries from stakeholders within predefined turnaround times.
- Relationship Building: Developing and maintaining healthy working relationships with internal and external stakeholders to ensure smooth claims processing.
- Follow-Ups: Providing feedback and resolving queries to keep stakeholders updated on the progress of claims.
Qualifications and Experience Required
To qualify for the Consultant: Medical Management role, candidates need to meet specific educational and professional criteria:
Educational Requirements
- Degree: A Bachelor’s Degree or Advanced Diploma in Health Sciences or a related medical field is required.
- Professional Registration: Candidates must be registered with the Health Professions Council of South Africa (HPCSA) or the South African Nursing Council (SANC).
Experience
- Medical Environment: At least three years of relevant experience in a medical-related environment is essential.
Key Competencies
A successful Consultant: Medical Management at the RAF will possess both technical and behavioral competencies, including:
- Claims Management Knowledge: Understanding the processes and systems involved in medical claims management.
- Medical Case Management: Expertise in managing medical cases and reviewing bills.
- Problem-Solving Skills: Ability to identify complex problems and make informed decisions.
- Customer Service: Strong client service orientation with the ability to handle sensitive queries professionally.
- Judgement: Sound judgment and decision-making abilities to handle medical exceptions and escalations.
- Clinical Analytical Skills: Strong analytical capabilities to assess medical claims critically.
- Ethics: High ethical standards, ensuring fair and equitable treatment of claimants.
Salary and Employment Details
The Consultant: Medical Management position offers a competitive salary of R501,775.00 per annum on a T.A.S.K Grade 11. It is important to note that the RAF offers a Total Employment Cost package, which means there are no additional employer contributions. Successful candidates will have the flexibility to structure their remuneration packages according to their needs.
This is a fixed-term contract for 12 months, providing an opportunity for candidates to gain valuable experience within a high-impact organization.
Employment Equity and Accessibility
The Road Accident Fund is committed to employment equity, and this particular role is not targeted at candidates with disabilities. However, the RAF strongly subscribes to the principles of employment equity, and preference will be given to previously disadvantaged candidates where applicable.
Application Process
To apply for this exciting opportunity, candidates are required to submit their applications before the closing date of 25 October 2024. It is important to note that applicants who have not received any feedback from the RAF within six weeks of the closing date can assume their application was unsuccessful.
Additionally, all prospective employees will undergo security vetting, and candidates with foreign qualifications must have their qualifications evaluated by the South African Qualifications Authority (SAQA).
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The Consultant: The Medical Management position at the RAF presents an excellent opportunity for medical professionals looking to contribute to the well-being of South Africans. With a focus on medical assessments, exception handling, and claims processing, this role is integral to the RAF’s mission of providing timely and caring support to those injured in road accidents. If you are passionate about medical management and have the necessary qualifications and experience, this is your chance to make a real difference.