Position: Medical Management Consultant(x8)

Location:  Johannesburg, Gauteng

Job Posting Salary:  R501,775.00

Closing date: 28 January 2025

requirements:

Qualifications

Bachelor’s Degree/Advanced Diploma in Health Sciences /Medical related qualification.
Registration with HPCSA/SANCA.

Experience

Relevant 3 years’ experience in a Medical related environment.

Key Performance Areas

• Conduct assessments and bill reviews on submitted claims, focusing on the appropriate level of care, the length of stay, and quality of care.
• 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.
• Pre authorise submitted claims aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tarrifs.
• Escalation of complex cases for multi disciplinary review and adjudication.
• Participate in the consultations process on the implementation of medical claims processes.

Position: Pre-Assessment Consultant (X10)

Location:  Johannesburg, Gauteng

Job Posting Salary:  R434,656.00

Closing date: 28 January 2025

requirements:

Qualifications

• Bachelor’s Degree/ Advanced Diploma in a related qualification.

Experience

• Relevant 3 years’ experience in the claims environment.

Key Performance Areas:

• Record all the submitted documents for prospective claims.
• Determine the benefits and the products submitted based on the submitted documents.
• Assess the submitted documents to determine compliance as per defined processes and rules.
• Apply compliance and/ lodgment rules in pre-accessing the prospective claim.
• Identify duplicate claims and linked claims.
• Examine the prescription of lodgment and apply prescription rules.
• Verify mortality with Home Affairs
• Communicate the assessment outcomes to the prospective claimants.

Position: Fraud Awareness Manager

Location:  Centurion, Gauteng

Job Posting Salary:  R1,028,791.00

Closing date: 28 January 2025

Qualifications and Experience:

• Bachelor’s Degree/ Advanced Diploma in Forensic related qualification. 
• Postgraduate in Forensic related qualification will be an added advantage.
• Drivers licence.
• Relevant 6 – 8 years’ experience in Forensic environment of which 2 years must have been on management level/ supervisory level/ area of expertise.
• Training background in fraud awareness and forensics.

Key Performance Areas

• Prepare fraud awareness presentation.
• Liaise with relevant RAF branch to arrange logistics with regard to event.
• Communicate date and time of event to stakeholders.
• Conduct fraud and corruption awareness event.
• Respond to questions posed during event.
• Promote anonymous fraud report line.

Position: Actuarial Analyst

Location:  Centurion, Gauteng

Job Posting Salary:  R579,259.00

Closing date: 28 January 2025

Qualifications and Experience:

• Bachelor’s Degree/ Advanced Diploma in Actuarial Science/ Mathematics related qualification.
• Relevant 4 years’ experience in an Actuarial environment.
• 1 year experience in Quantification of Damages (Loss of Earnings and Loss of Support) will be advantageous.
• Professional actuarial exams passed are advantageous.

Key Performance Areas:

• Investigate the potential impact of various assumptions underlying loss of income calculations such as discount rates, mortality and morbidity rates, contingencies, earnings progression, inflation, taxation, remarriage, inheritance and accelerated benefits, etc.
• Assist with expense investigation for the company budgeting purposes.
• Produce appropriate reports for different relevant users of investigation results.
• Conduct statistical and regression analysis.

Position: Verification and Validation Consultant (X10)

Location: Johanneburg

Job Posting Salary:  R434,656.00

Closing date: 28 January 2025

requirements:

Qualifications

• Bachelor’s Degree/ Advanced Diploma in a related qualification.

Experience

• Relevant 3 years’ experience in the claims enviroment.

Key Performance Areas:

• Apply sound legal RAF Act and Regulations to Act, Case Law) knowledge on daily basis to validate claims.
• Search for and apply relevant Case Law during verification and validation.
• Determine the need to call in the injured for questioning in line with the RAF act.
• Apply RAF procedures to validate the claims.
• Assess duplicate claims to address mandates and minimise further processing of duplicate claims.
• Examine and apply the prescription of rules at the claim and product level.
• Verify data and information with relevant stakeholders.

Application:

To send your application, please visit https://careers.raf.co.za/search/?createNewAlert=false&q=&optionsFacetsDD_department=&optionsFacetsDD_city=