18 Medical Management jobs in South Africa

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.

What will you do?

To form a component of the GEMS: clinical risk management/ fund management support structure. Conduct research and draft documentation and spearhead internal projects related to the work of the clinical risk or fund management teams. Support the Advanced Specialist: Strategic Sourcing with the development of the strategic sourcing strategy through the identification of cost drivers

drivers including gathering of relevant data from various sources.

• Provide effective and valuable input and guidance to the scheme to support the management of clinical risk
• Oversee the specific SPN relationship together with the fund manager and or senior/advanced clinical risk specialist
• The requirement is to ensure that all SPN operations concerns and requirements are communicated to the Fund managers for awareness and assist with actioning where required with internal role-players
• Perform the majority of medicines-related action items and tactical responses arising from the Scheme meetings
• Preparation of slides for various meetings to address medicines related agenda items and strategic inputs
• Presentation of slides at meetings and fielding of questions
• Handling of Scheme queries and tactical responses as they relate to all medicines matters, including but not limited to: Vaccination, MEL and MPL impact analyses, stock-outs and their impact, trend anomalies and expert panels
• Co-ordination and secretariat for Expert Panels
• Development of Medicine proposals
• Development of Medical Device proposals
• Ad-hoc analyses to support proposals
• Ad-hoc medicine requests
• Ad-hoc appliances request
• Participate in various strategic projects

Qualification and Experience:

• Qualified Pharmacist or Clinical Qualification
• 6 - 8 years' experience in managed care, claims, clinical coding and data analysis
• Knowledge of legislation, industry, PMB, NHI

Knowledge and Skills:

• Knowledge and application of relevant legislation
• Knowledge and application of processes and procedures
• Product and scheme rule knowledge

Turnaround Time

The shortlisting process will only start once the application due date has been reached. The time taken to complete this process will depend on how far you progress and the availability of line managers.

Our Commitment to Transformation

AfroCentric is committed to transformation and embracing diversity. Our Employment Equity plan and targets will be considered as part of the recruitment process. This commitment is what drives us to achieve a diverse workplace with employment equity as a key goal to create an inclusive workforce, representative of the demographics of our society as well as people with disabilities.

Should you not hear from us within a month of applying, consider your application unsuccessful.