28 Clinical Manager jobs in South Africa

Project Leads are an integral part of clinical trial delivery, liaising with clinical teams to improve patients' lives by bringing new drugs to the market faster. The Project Lead is an essential member of the core project team responsible for project delivery of clinical studies to meet contractual requirements in accordance with SOPs, policies and practices. Clinical Project Management is focused on project delivery, productivity and quality resulting in strong financial performance and customer satisfaction. Clinical Project leads can run their own studies. The Project Lead focus is on leveraging therapeutic expertise and IQVIA's suite of solutions to drive operational excellence and strategic leadership with our customers

Essential Functions

• Participate in bid defense presentations in partnership with Business Development and may lead the presentation for smaller, less complex regional studies.
• May be responsible for delivery and management of smaller, less complex, regional studies.
• Develop integrated study management plans with the core project team.
• Accountable for the execution of clinical studies, or assigned portion of clinical studies, per contract while optimizing speed, quality and cost of delivery and ensuring consistent use of study tools and training materials and compliance with standard processes, policies and procedures.
• Set objectives of the core project team and/or sub-team(s) according to agreed upon contract, strategy and approach, effectively communicate and assess performance.
• Collaborate with other functional groups within the company where necessary to support milestone achievement and to manage study issues and obstacles.
• Monitor progress against contract and prepare/present project and/or sub-team information proactively to stakeholders internally and externally.
• Manage risk (positive and negative) and contingencies proactively and lead problem solving and resolution efforts.
• Achieve project quality by identifying quality risks and issues, responding to issues raised by project team and/or sub-team members and planning/implementing appropriate corrective and preventative action plans.
• May serve as primary or backup project contact with customer and would then own the relationship with the project's key customer contacts, as well as communicate/collaborate with IQVIA business development representatives, as necessary.;
• Build the cross-functional project team and lead their efforts; responsible for managing cross-collaboration of the core team and for overall project delivery to support milestone achievement and to manage study issues and obstacles.;
• Ensure the financial success of the project.
• Forecast and identify opportunities to accelerate activities to bring revenue forward.
• Identify changes in scope and manage change control process as necessary.
• Identify lessons learned and implement best practices.
• May be assigned as the primary contact for vendors leading project vendor management and vendor management related activities as per project requirements.;
• Adopt corporate initiatives and changes and serve as a change advocate when necessary.
• Provide input to line managers of their project team members' performance relative to project tasks.
• Support staff development and mentor less experienced project team members on assigned projects to support their professional development.;

Qualifications

• Bachelor's Degree Life sciences or related field
• 5 years of prior relevant experience including > 1 years project management experience or equivalent combination of education, training and experience.
• Advanced knowledge of job area, and broad knowledge of other related job areas, typically obtained through advanced education combined with experience.
• Knowledge of clinical trials - Knowledge of clinical trial conduct, and skill in applying applicable clinical research regulatory requirements i.e. ICH GCP and relevant local laws, regulations and guidelines, towards clinical trial conduct.

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more

Location: Cape Town

Reporting to: Executive Clinical Division Lead (ExCo)

Employment Type: Full-Time

Salary: R33,000.00

Start Date: 1st November

Workability is a national value-based healthcare company working with funders and a network of physiotherapy and occupational therapy practices across South Africa. We're reshaping care delivery through outcome-driven models that put function, quality, and equity at the centre.

We're looking for a Clinical Governance Manager to join our Management Committee (MANCO) and help drive governance, quality, and clinical accountability across our growing platform. This is a strategic, hands-on role for someone with both operational excellence and clinical insight.

About the Role

This role is ideal for someone who thrives in complexity, adapts quickly, and sees opportunities in uncertainty. You'll work closely with the Executive Clinical Lead and manage our Clinical QA Administrator. You'll be responsible for developing and executing clinical governance processes, ensuring quality across our national network, and embedding a learning, ethical, and accountable culture.

This role suits someone who thrives in a dynamic environment. Each day may look a little different, so we're looking for someone proactive, solutions-oriented, and comfortable taking initiative. You'll need to be confident working independently, able to spot gaps and opportunities, and skilled at turning ideas into structured, meaningful action. Clear thinking, adaptability, and clinical insight will be key to your success.

Key Responsibilities

• Lead the execution of the clinical governance strategy, ensuring alignment with the vision and strategic priorities of the Clinical Division.
• Design, implement, and continuously improve clinical governance systems, including quality assurance, clinical audit, compliance, and risk mitigation frameworks.
• Establish ethical oversight and performance monitoring systems across the therapist network, clinical pathways, and clinical products.
• Monitor clinical KPIs and safety indicators, leveraging data insights to guide improvement, risk management, and accountability.
• Support and drive continuous quality improvement, embedding learning loops, feedback structures, and performance reviews that lead to measurable change.
• Ensure internal governance and compliance frameworks align with both local and international standards for quality, safety, and ethical care.
• Serve as a key member of the Management Committee (MANCO), providing leadership input on clinical safety, quality, and operational risk at a strategic level.
• Translate high-level strategy into day-to-day execution, ensuring plans are grounded, actionable, and coordinated across departments.
• Collaborate across company divisions, including Operations, Training, Finance, IT, and the Clinical Network to ensure integrated, patient-centred systems.
• Foster a culture of shared leadership, accountability, and learning, promoting psychological safety and ethical practice throughout the clinical network.

What We're Looking For

• A qualified healthcare professional with experience in clinical governance, quality assurance, or clinical management.
• A proven track record in healthcare leadership (MANCO/management level experience preferred).
• Deep understanding of clinical risk, quality improvement, and evidence-informed care.
• Strategic thinker with strong operational execution skills.
• Experience in working across interdisciplinary teams and networks.
• Excellent communication, emotional intelligence, and the ability to lead both people and processes.
• Comfortable working independently in an evolving, non-linear environment.
• Familiarity with value-based care models and outcome-based performance systems is a strong advantage.

Experience, Skills & Attributes:

• A qualified healthcare professional with experience in a clinical setting (I.e., Occupational Therapist, Physiotherapist).
• 2–3 years clinical experience in practice, ideally in vocational rehabilitation or complex case management.
• At least 3 years of experience working in a corporate or structured organisational environment.
• Minimum 1 year of management or leadership experience, including line management, quality oversight, or governance responsibilities.
• Bonus: Exposure to COIDA, vocational rehab, chronic pain, and interdisciplinary teams.
• Highly computer literate:
• Proficient in Microsoft Office, with exceptional Excel skills.
• Skilled in Google Drive and its associated tools (Docs, Sheets, Slides, Forms).
• Comfortable working with cloud-based systems, collaborative tools, and digital communication platforms.
• A curious, tech-forward mindset, comfortable with exploring emerging technologies.
• Willingness to embrace AI tools and digital platforms that enhance clinical governance, quality assurance, and team productivity.

Core Competencies:

• Strong critical thinking, systems awareness, and problem-solving ability.
• Highly organised, detail-focused, and able to follow through to completion.
• Clear, confident verbal and written communicator.
• Able to work independently, proactively, and without micro-management.
• Comfortable operating in fast-paced, evolving environments.
• A natural planner who can adapt strategies and pivot when needed.
• Demonstrates personal attributes that include:
• Diligence, persistence, and consistency.
• Patience, calm under pressure, and a steady, professional demeanor.
• A mature, confident communicator with both internal and external stakeholders.

Remote Work Requirements

• This is a remote-first role with in-person teamwork days at least twice per month.
• Candidates must have:
• A stable, high-speed internet connection.
• Appropriate load-shedding back-up solutions to ensure uninterrupted work.

Why Join Workability?

• Be part of a national movement shaping the future of rehabilitation in South Africa.
• Influence care design, delivery, and quality at a systems level.
• Work with an organisation deeply committed to equity, outcomes, and ethical care.
• Contribute to a division that doesn't just deliver care — it sets the benchmark for excellence.

Looking for data management expert, who has prior experience in performing scientific (complex) clinical data review in close collaboration with the Study Responsible Physicians (SRP) and Study Responsible Scientists (SRS)

Prior experience of closely collaborating with the SRP, SRS, Data Management functions and the rest of the study team members when implementing the data management related activities for protocols, with focus on more complex indication and therapy related elements of the study.

Has prior experience of being involved and driving discussions with SRP/SRS and collaborates with the Data management team to establish, align, and confirm scientific clinical data review expectations for assigned trial(s).

Extensive prior experience of 4+ years supporting studies within the therapeutic area Oncology or CV&M.

Rave experience mandatory

Deliverables:

• Services rendered will adhere to applicable Client SOPs, WIs, policies, local regulatory requirements, ICH-GCP, etc.
• Provides scientific data review support for more than one low to moderate complexity trial or one high complexity trial.
• The data management expert who, within the therapeutic area, is performing scientific (complex) clinical data review in close collaboration with the Study Responsible Physicians (SRP) and Study Responsible Scientists (SRS). Tapping into technical and clinical expertise, closely collaborating with the SRP, SRS, Data Management functions and the rest of the study team members when implementing the data management related activities for protocols, with focus on more complex indication and therapy related elements of the study. Reviews all necessary data flows, the Data Management Plans and performs continuous (complex) data review activities on the studies in the assigned program.
• Involved in study related activities from the protocol design stage onwards, providing input into the study specific and/or indication specific data collection tools.
• Reviews (complex) scientific study data, manages CDM and SRS/SRP related queries in EDC system. Involvement in other review activities (e.g., Coding, SAE reconciliation) is possible.
• Leads and/or attends meetings as appropriate.
• Takes a leadership role with SRP/SRS and collaborates with the GDM to establish, align and confirm scientific clinical data review expectations for assigned trial(s).
• With the trial customer, CRO and other functional partners in relation to CDM related activities:
• Reviews content and integration requirements for eCRF and other data collection tools
• Establishes conventions and quality expectations for clinical data.
• Set timelines and follow‐up regularly to ensure delivery of all Clinical Data Management milestones
• Creates the Integrated Review Plan ensuring appropriate quality, scientific content, organization, clarity, accuracy, format, and consistency. Reviews related clinical data management documents. Ensures compliance with regulatory guidelines and documentation requirements.
• Ensures real‐time inspection readiness of all assigned deliverables for the trial; participate in Regulatory Agency inspection and Client internal audits as necessary.
• Plans and tracks applicable CDM deliverables. Ensures CDM deliverables are on time.
• Takes a leadership role in collaborating with the SRS/SRP to ensure that DM and Therapeutic Area trial needs and deliverables are met.
• Identifies and communicates lessons learned, best practices and frequently asked questions at the trial level.
• Identifies and participates in process, system, and tool improvement initiatives within clinical data management.
• Therapeutic Area - Oncology, Cardiovascular and Immunology

Education/Experience

• BS/BA degree or higher preferably in Health Sciences, or BS/BA degree or higher with professional clinical experience/exposure.
• 4 years Data management experience. Data Management experience preferably including clinical data review or significant experience with clinical data review. Knowledge in medical terminology would be preferable
• Must have experience in supporting the eCRF build
• Rave knowledge and experience mandatory

This role is not eligible for UK visa sponsorship
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more

Division: Claims

Reference No: 6084

Location:

East London, Eastern Cape, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): Yes

T.A.S.K Grade: 11

Job Posting Salary: R501,775.00

Job Posting End Date: 25 Sep 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
CONSULTANT: MEDICAL MANAGEMENT T.A.S.K GRADE 11 (X24)
Note: These are 36-month, fixed-term contract positions
Purpose of the job:
The
Consultant: Medical Management
is responsible for implementing the medical management activities, medical exception handling and providing administration support in claims processing.

Key Performance Areas
Medical management

• Conduct medical assessment and compile injury assessment reports.
• 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.
• Preauthorize submitted claims aligned to RAF clinical guidelines including the RAF formulary, treatment protocols and related tariffs.
• Escalation of complex cases for multi-disciplinary review and adjudication.
• 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.
• Maintain the documentation and regular updating of the exception handling process.
• Maintain the implementation of an unusual occurrence procedure.

Reporting

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.
• Produce documents, briefing papers, reports, and presentations.

Stakeholder management

• Deal with/and respond to correspondence.
• Maintain healthy relationships with all stakeholders.
• Follow up and resolve all queries and make recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
• Respond to queries within the predefined turnaround times.

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

Technical And Behavioral Competencies Required

• Claims management process/ processes and systems.
• Medical product management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Customer value proposition
• Strong clinical analytical capabilities
• Knowledge of motor vehicle accident legislation
• Planning, Organising and Coordinating.
• Personal Mastery.
• Judgement and Decision Making.
• Ethics and Values.
• Client Service Orientation.

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."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: Claims

Reference No: 6068

Location:

Johannesburg, Gauteng, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): No

T.A.S.K Grade: 11

Job Posting Salary: R501,775.00

Job Posting End Date: 28 Oct 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
NB: This is a Three (3) years Fixed-Term Contract position
Purpose of the job:
The
Consultant: Medical Management
is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

Key Performance Areas
Medical Management.

• Conduct medical assessment and compile injury assessment reports.
• 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.

Exception Handling.

• Ensure the implementation and maintenance of a formal exception handling process within the medical management.
• Maintain the documentation and regular updating of the exception handling process.
• Maintain the implementation an unusual occurrence procedures.

Reporting.

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.
• Produce documents, briefing papers, reports and presentations.

Stakeholder Management

• Deal with/and respond to correspondence.
• Maintain healthy relationships with all stakeholders.
• Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
• Respond to queries within the predefined turnaround times.

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.

Technical And Behavioral Competencies Required

• Claims management process/ processes and systems.
• Medical product management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Customer value proposition
• Strong clinical analytical capabilities
• Knowledge of motor vehicle accident legislation
• Planning, Organising and Coordinating
• Personal Mastery
• Judgement and Decision Making
• Ethics and Values
• Client Service Orientation

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."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: 3300

Reference No: 6070

Location:

Johannesburg, Gauteng, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): No

T.A.S.K Grade: 06

Job Posting Salary: R244,732.00

Job Posting End Date: 24 Oct 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
NB: This is a Three (3) Years Fixed-Term Contract position
Purpose of the Job:
The Administrative Assistant is responsible for providing administrative day-to-day support to the Medical Management Department.

Key Performance Areas
Compliance Administration

• Maintain up-to-date written documentation related to the departments business activities.
• Ensure compliance to the policies and process standards.
• Keep abreast of internal standards and business goals to ensure adherence to sound internal control.

Office Coordination

• Assist in making follow-ups on outstanding matters.
• Ensure all requests are handled and responded to within set timelines.
• Assist in ensuring the availability of stationery within the department.
• Validate and verify information and documents submitted for accurate capturing and further handling.
• Ensure the systems/registers used are kept up to date.
• Check for duplicate documents, requests and queries and report on them.
• Allocate reference numbers and accurately capture related documents on different systems.
• Allocation of matters to responsible team members.
• Draft and send out letters to all stakeholders as required.

Meeting Support

• Arranging meetings on behalf of the department.
• Assist with taking and distributing minutes in accordance to set governance standards.
• Create and maintain a register to track matters outstanding.
• Maintain a follow-up plan on meeting resolutions and matters outstanding.
• Ensure confirmation of meetings and management of team diaries.
• Schedule appointments with internal and external stakeholders as and when required.

Document and Records Management

• Administer the records management and filling processes in line with the RAF filling plan
• Ensure that the filing system is always up-to-date and functional.
• Retrieval of information at all times as requested in the office.
• Ensure confidentiality of all documents under control and that documentation reaches the intended recipients.
• Acknowledge the receipt of documentation, apply a file number allocation, record data onto the computer system and file appropriately.

Qualifications

• Matric or Grade 12 certificate.

Experience

• Relevant 1 years' experience in Administrative or similar environment.

Competencies

• Behavioural

• Planning, Organising and Coordinating

• Personal Mastery
• Emotional wisdom and Decision Making
• Ethics and Values

• Client Service Orientation

• Technical

• Computer literacy in MS Word, Excel, PowerPoint.

• Excellent planning and organisational skills.
• Good administrative skills.
• Ability to access required information.
• Writing skills.
• Basic understanding of SCM processes.
• Basic financial acumen.

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."
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: Operations

Reference No: 5996

Location:

Durban, Kwazulu-Natal, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): Yes

T.A.S.K Grade: 11

Job Posting Salary: R501,775.00

Job Posting End Date: 15 Oct 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
Purpose of the Job:
The Consultant: Medical Management is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

NB: This is a 3 Years Fixed Term Contract.
Key Performance Areas
Medical management.

• Conduct medical assessment and compile injury assessment reports.
• 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.
• Preauthorize submitted claims aligned to RAF clinical guidelines including the RAF formularory, treatment protocols and related tariffs.
• Escalation of complex cases for multi-disciplinary review and adjudication.
• 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.
• Maintain the documentation and regular updating of the exception handling process.
• Maintain the implementation of an unusual occurrence procedure.

Reporting.

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad hoc reports on process improvement initiatives.
• Produce documents, briefing papers, reports and presentations.

Stakeholder management.

• Deal with/and respond to correspondence.
• Maintain healthy relationships with all stakeholders.
• Follow up and resolve all queries, following up and making recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
• 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.

Behavioral competencies

• Planning, organization and coordinating.
• Personal mastery.
• Judgement and Decision Making
• Ethics and values.
• Client service orientation

Technical competencies

• Claims management process/ processes and systems
• Medical product management
• Medical bill reviewing
• Medical case management
• Complex problem identification, solving and decision making
• Customer value proposition
• Strong clinical analytical capabilities
• Knowledge of motor vehicle accident legislation

The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.

Division: Operations

Reference No: 5908

Location:

Menlo Park, Gauteng, ZA

Employment Type: Fixed Term Contract

Disability (EE targeted role): No

T.A.S.K Grade: 11

Job Posting Salary: R501,775.00

Job Posting End Date: 16 Sep 2025

The Road Accident Fund's mission is to provide appropriate cover to all road users within the borders of South Africa; to rehabilitate and compensate persons injured as a result of motor vehicle accidents in a timely and caring manner; and to actively promote safe use of our roads.
Note: THIS IS A THREE (3) YEAR FIXED TERM CONTRACT
Purpose of the Job:
The
Consultant: Medical Management
is responsible to implement the medical management activities, medical exception handling and providing administration support in claims processing.

Key Performance Areas
Medical Management

• Conduct medical assessment and compile injury assessment reports.
• 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 formulary treatment protocols and related tariffs.
• Escalation of complex cases for multi-disciplinary review and adjudication.
• 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.
• Maintain the documentation and regular updating of the exception handling process.
• Maintain the implementation an unusual occurrence procedures.

Reporting

• Track and report against set objectives and targets.
• Report on emerging risks.
• Provide ad-hoc reports on process improvement initiatives.
• Produce documents, briefing papers, reports and presentations.

Stakeholder Management

• Deal with/and respond to correspondence.
• Maintain healthy relationships with all stakeholders.
• Follow up and making recommendations on which corrective actions are appropriate.
• Follow up and feedback to all stakeholders to keep them updated on the status of a query.
• 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

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".
The Road Accident Fund subscribes to the principles of employment equity and preference will be given to People with Disabilities.
Applicants who have not received any correspondence from us within six weeks from the closing date can consider themselves unsuccessful
Security Vetting shall be conducted on all prospective employees
It is the applicants' responsibility to have foreign qualification evaluated by the South African Qualification Authority (SAQA) and to provide proof of such evaluation.