Road Accident Funds (RAF) Apply by 31 January 2025!

1. Officer: Legal Administration (x15)

Location: Johannesburg, Gauteng, ZA | Reference No: 5264 | Job Posting Salary: R434,656.00 | Job Posting End Date: 7 Feb 2025 |

Job Introduction:

The Road Accident Fund (RAF) is a pivotal organization in South Africa, dedicated to providing comprehensive cover to all road users. Beyond compensation, the RAF focuses on rehabilitating individuals injured in motor vehicle accidents, settling claims promptly, and promoting road safety. Currently, the RAF is recruiting for 15 Officer: Legal Administration roles within their Governance Division in Johannesburg, Gauteng. This 12-month fixed-term contract offers a competitive salary of R434,656.00 per annum, targeting skilled legal professionals passionate about efficiency and dispute resolution.

This role demands expertise in legal administration, mediation, and managing documentation crucial to claims settlements. If you are a legal professional with a keen eye for detail and exceptional organizational skills, this opportunity provides a rewarding platform to make a meaningful impact on the lives of South Africans.

Role Responsibility:

Effective Management of Staff:

Collaborate with colleagues to transcribe and proofread legal documents related to settlement discussions.
Ensure efficient retrieval and dissemination of critical information for claims processing and dispute resolution.
Promote a team culture of confidentiality and professionalism when handling sensitive documentation and case files.
Oversee the administration of arbitration processes and hearings to ensure smooth procedural operations.

Effective Management of Operations:

Collate and update directives, ensuring they are accurately reflected in the case file database.
Brief experts for arbitration and claims purposes, ensuring all relevant evidence and documentation are gathered.
Organize and manage hearing sessions, ensuring all required parties present the necessary evidence or information.
Maintain an effective filing system for settlement agreements, ensuring ease of access and compliance with RAF policies.
Diarize and monitor court processes, ensuring deadlines and procedural requirements are met.
Arrange block settlement meetings to streamline group settlements and coordinate required court documentation.

Effective Management of Business Development Function:

Contribute to the preparation and submission of periodic and ad-hoc reports.
Regularly update management on claims progress to support decision-making and organizational objectives.
Build proactive relationships with both internal and external stakeholders to enhance claims settlement processes.
Respond promptly to inquiries and requests for information, demonstrating a client-service-oriented approach.

The Ideal Candidate:

To excel as an Officer: Legal Administration, candidates must meet the following qualifications, experience, and competency requirements:

Qualifications:

A Bachelor’s Degree in Law or an equivalent qualification is required.

Experience:

A minimum of 3 years’ relevant experience in a Legal Administration-related environment.

Skills and Attributes:

Dispute Resolution and Mediation:

Proficiency in resolving disputes and mediating settlements effectively.
Strong negotiation skills to support out-of-court settlements.

Legislation and Regulatory Knowledge:

In-depth understanding of Personal Injury and Third-party Compensation laws.
Comprehensive knowledge of civil proceedings in the Magistrate, Regional, and High Courts of South Africa.

Planning and Coordination:

Exceptional organizational skills to handle multiple claims and manage case files efficiently.
Ability to monitor and coordinate court processes, ensuring accuracy and adherence to timelines.

Judgment and Decision-Making:

Analytical abilities to assess claims offers and provide clarity in case evaluations.
Ethical decision-making aligned with organizational and legal standards.

Client Service Orientation:

A proactive approach to building and maintaining relationships with stakeholders.
Strong communication skills to provide clear and timely information to all parties involved.

Technical Expertise:

Proficiency in managing legal documentation, proofreading, and transcription.
Experience with arbitration processes and managing settlements.

This position is an excellent opportunity for legal professionals to apply their expertise in an impactful environment. The Officer: Legal Administration role at RAF not only offers competitive compensation but also provides a chance to contribute to South Africa’s road safety and claims management initiatives.

Interested and qualified candidates are encouraged to apply before the closing date on 7 February 2025. The Road Accident Fund seeks professionals who are dedicated to excellence, detail-oriented, and driven to deliver exceptional client service.

By joining the RAF, you will be part of a team that values integrity, professionalism, and a commitment to making a difference. If you meet the qualifications and are ready to take on this challenging yet rewarding role, don’t hesitate to apply and become a part of this vital organization.

2. RAF Attorney: High Court

Job Introduction:

The Road Accident Fund (RAF) is seeking a highly skilled and experienced RAF Attorney: High Court to join their team in Makhanda, Eastern Cape. This permanent role is critical to the RAF’s mission of providing timely and compassionate compensation to road accident victims while promoting road safety across South Africa. The successful candidate will be responsible for managing high court litigation matters, offering legal advice, and ensuring compliance with South African laws and regulations. With a competitive salary of R1,028,791.00, this role is an excellent opportunity for a seasoned legal professional to make a meaningful impact.

Role Responsibility:

The RAF Attorney: High Court will play a pivotal role in managing high court litigation and providing legal expertise to the organization. Key responsibilities include:

Policy Review and Implementation:
- Contribute to the development and implementation of departmental policies and procedures.
- Stay updated on effective policy execution strategies to ensure compliance and efficiency.
Preparation and Research on Litigation Matters:
- Conduct thorough research to prepare for trial cases.
- Consult with clients, representatives, and witnesses to gather necessary documentation and instructions.
- Draft pleadings to present clear and justified legal arguments.
Mediation Process:
- Oversee the mediation process in accordance with court rules.
- Ensure timely communication with all parties and the Registrar upon completion of mediation.
- Issue joint minutes within five days of mediation completion.
Representation in Third-Party Claims:
- Attend court appearances for third-party litigation matters.
- Manage file administration from case opening to conclusion, ensuring adherence to trial dates.
- Handle appearances at courts, tribunals, and mediation hearings.
Settlement of Non-Litigious Matters:
- Assess files early and consult with experts to settle matters before trial.
- Recommend settlements and approve requests for expert witnesses and assessors.
Provision of Legal Advice:
- Offer legal advice on contracts and other legal matters impacting the RAF.
- Conduct legal research and prepare detailed legal opinions.
Taxation:
- Provide comprehensive tax services in compliance with South African laws.
- Build client relationships and offer innovative tax planning solutions.
Reporting:
- Prepare and submit regulatory reports to update management on progress.
- Develop policies, procedures, and functional reporting systems aligned with RAF’s strategy.
Stakeholder Management:
- Facilitate communication with internal and external stakeholders.
- Manage vendor relationships and ensure timely payment of invoices.
People Management:
- Recruit, develop, and retain a high-performance team.
- Manage staff performance and implement human capital processes to address workplace conflicts.

Effective Management of Staff:

Ensure the recruitment and retention of a skilled workforce aligned with employment equity targets.
Motivate and evaluate team members to achieve individual and organizational goals.
Implement human capital processes to manage workplace conflicts and maintain standards.

Effective Management of Operations:

Oversee the administration of legal cases, ensuring compliance with trial dates and court requirements.
Coordinate administrative legal actions and approve instructions for expert witnesses.
Develop and implement operational policies and procedures to enhance efficiency.

Effective Management of Business Development Function:

Build and maintain relationships with stakeholders to support organizational goals.
Develop innovative solutions to improve service delivery and client satisfaction.
Ensure compliance with legal and regulatory requirements to mitigate risks.

The Ideal Candidate:

The ideal candidate for the RAF Attorney: High Court role will possess the following qualifications and experience:

Qualifications:
- Bachelor’s Degree in Law or equivalent.
- Postgraduate qualification in Law or equivalent.
- Admission as an Attorney of the High Court or Advocate.
- Right of appearance in the High Court.
Experience:
- 5-7 years of relevant legal experience post-graduation or admission.
- At least 2 years of experience in personal injury litigation.

Skills and Attributes:

Behavioural:
- Resilience and strong communication skills.
- Ability to work effectively with people and build networks.
- Excellent planning, organizing, and coordination abilities.
- High ethical standards and client service orientation.
Managerial:
- Expertise in change management, coaching, and conflict resolution.
- Strong critical and innovative thinking skills.
- Proficiency in policy formulation, risk management, and stakeholder relations.
Technical:
- In-depth knowledge of legislation, regulatory frameworks, and MVA law.
- Strong negotiation, mediation, and problem-solving skills.
- Experience in claims litigation and governance.

This role offers a unique opportunity to contribute to the RAF’s mission while advancing your legal career. If you meet the qualifications and are passionate about making a difference, apply before the closing date of 11 February 2025. Join the RAF and play a key role in promoting justice and road safety in South Africa.

3. Consultant: Medical Management x5

Location: Durban, Kwazulu-Natal, ZA | T.A.S.K Grade: 11 | Job Posting Salary: R501,775.00 | Job Posting End Date: 11 Feb 2025 |

Job Introduction:
The Road Accident Fund (RAF) is a leading organization dedicated to providing cover to all road users within South Africa. Their mission is to rehabilitate and compensate individuals injured in motor vehicle accidents promptly and compassionately while promoting road safety. The RAF is currently seeking a Consultant: Medical Management to join their Operations Division in Durban, KwaZulu-Natal. This is a 36-month Fixed Term Contract role with a competitive salary of R501,775.00.

If you are a qualified health professional with a passion for medical management and claims processing, this role offers an exciting opportunity to contribute to a meaningful cause.

Role Responsibility:

The Consultant: Medical Management will play a critical role in implementing medical management activities, handling medical exceptions, and providing administrative support in claims processing. Below are the key responsibilities:

Medical Management

Conduct medical assessments and compile detailed injury assessment reports.
Review and assess submitted claims, focusing on the appropriateness of care, length of stay, and quality of care.
Ensure adherence to RAF tariffs, cost-saving initiatives, and treatment protocols.
Pre-authorize claims in alignment with RAF clinical guidelines, formularies, and treatment protocols.
Escalate complex cases for multidisciplinary review and adjudication.
Participate in consultations to improve medical claims processes.

Exception Handling

Implement and maintain a formal exception-handling process within medical management.
Document and regularly update exception-handling procedures.
Manage unusual occurrence procedures effectively.

Reporting

Track and report on set objectives and targets.
Identify and report on emerging risks.
Provide ad-hoc reports on process improvement initiatives.
Prepare documents, briefing papers, reports, and presentations.

Stakeholder Management

Respond to correspondence and queries promptly.
Maintain positive relationships with all stakeholders.
Resolve queries and provide feedback to stakeholders within predefined turnaround times.

The Ideal Candidate:

The ideal candidate for this role will possess a combination of qualifications, experience, and key competencies.

Qualifications

Bachelor’s Degree or Advanced Diploma in Health Sciences or a related medical field.
Registration with the Health Professions Council of South Africa (HPCSA) or South African Nursing Council (SANCA).

Experience

A minimum of 3 years of experience in a medical-related environment.

Skills and Attributes

Strong clinical analytical capabilities.
Knowledge of motor vehicle accident legislation.
Proficiency in claims management processes and systems.
Expertise in medical product management and bill reviewing.
Ability to identify, solve, and make decisions on complex problems.
Customer-focused with a strong value proposition mindset.

Behavioural Competencies

Planning, Organising, and Coordinating: Ability to manage tasks efficiently and meet deadlines.
Personal Mastery: Demonstrates self-awareness and a commitment to personal growth.
Judgement and Decision Making: Makes informed decisions based on sound judgment.
Ethics and Values: Upholds high ethical standards and integrity.
Client Service Orientation: Committed to delivering exceptional service to stakeholders.

Why Join the Road Accident Fund?

Meaningful Work: Contribute to a mission that impacts the lives of road accident victims and promotes road safety.
Professional Growth: Gain valuable experience in medical management and claims processing within a supportive environment.
Competitive Remuneration: Enjoy a competitive salary package and benefits.
Inclusive Workplace: The RAF is committed to diversity and inclusion, including targeted roles for individuals with disabilities.

4. Senior Officer: Field Case Management x4

Job Introduction:

The Road Accident Fund (RAF) is a pivotal institution in South Africa, dedicated to providing comprehensive cover to all road users within the nation’s borders. Its mission extends to rehabilitating and compensating individuals injured in motor vehicle accidents promptly and compassionately, while also advocating for road safety. The RAF is currently seeking to fill the position of Senior Officer: Field Case Management on a 12-month Fixed Term Contract basis. This role is crucial in driving the rehabilitation and healthcare needs of those injured in road accidents, ensuring they receive the necessary support and care to reintegrate into their families and communities effectively.

Role Responsibility:

The Senior Officer: Field Case Management is tasked with a variety of responsibilities aimed at ensuring the effective rehabilitation and care of claimants. Here’s a breakdown of the key performance areas:

Field Case Management:
- Activate undertaking certificates and compile detailed case management reports.
- Conduct home visits to educate claimants about the RAF’s offerings and the overall process.
- Perform follow-up assessments and recommend necessary actions based on the claimant’s needs.
- Coordinate referrals to appropriate service providers as per the undertaking certificate.
- Ensure the successful integration of claimants back into their families and educate both the claimant and their family about the claimant’s condition.
- Facilitate timely consultations with medical service providers.
- Provide vocational guidance and explore back-to-work opportunities post-life-changing events.
Rehabilitation Services:
- Monitor the rehabilitation progress of claimants post-discharge.
- Oversee drug utilization and application reviews.
- Assess caregiver levels and the associated financial implications.
- Determine claimant needs and facilitate recommendations for home and car modifications.
- Coordinate admissions and necessary authorizations as per caregiver SOPs and guidelines.
- Facilitate the appointment of caregivers and guide them through the process.
- Coordinate the monthly submission of timesheets for payment processing.
Financial Management:
- Ensure the accuracy and effective submission of invoices.
- Validate accounts submitted to the RAF in accordance with guidelines and the Road Accident Fund Act.
- Monitor claim invoices to prevent over-servicing, abuse, and fraudulent claims.
- Ensure timely payment of accounts as per service level agreements.
- Verify that services and treatments claimed are accident-related.
- Compare outcomes and costs of different therapeutic modalities and surgical techniques to develop clinical management guidelines.
Reporting:
- Compile and update case management reports for injured claimants.
- Provide reports on patient care and ongoing rehabilitation.
- Report on the services provided by service providers.
Stakeholder Management:
- Drive stakeholder interactions to facilitate the level of care required.
- Maintain relationships with various levels of health specialists.
- Participate in community awareness initiatives about RAF case management services.
- Communicate effectively with all levels of stakeholders.
- Engage in relevant external RAF activities and events.
- Maintain ongoing engagements with service providers.

The Ideal Candidate:

The ideal candidate for the Senior Officer: Field Case Management role will possess a blend of qualifications, experience, and competencies that align with the demands of the position.

Qualifications:
- Bachelor’s Degree or Advanced Diploma in Nursing/Allied Health Professions or a related field.
- Registration with the relevant Health Professions Council.
Experience:
- A minimum of 4 years of relevant experience in the medical environment.
- Experience in a Managed Healthcare environment.
- A valid code 8 driving license.
Behavioral Competencies:
- Strong planning, organizing, and coordinating skills.
- Personal mastery and a commitment to continuous improvement.
- Sound judgment and decision-making abilities.
- A strong sense of ethics and values.
- A client-service orientation with a focus on delivering high-quality care.
Technical Competencies:
- Knowledge of ICD and CPT coding.
- Core specialties in the case management process.
- A deep understanding of healthcare operations.
- The ability to maintain patient confidentiality.
- Full knowledge of medical tariffs and treatment plans.
- Familiarity with coding standards and protocols.
- Knowledge of the Public Finance Management Act (PFMA) to analyze different requirements as per the claimants.

5. Officer: Bill Review x2

Job Introduction:

The Road Accident Fund (RAF) is a pivotal organization in South Africa, dedicated to providing cover to all road users, rehabilitating and compensating victims of motor vehicle accidents, and promoting road safety. The RAF is currently seeking a diligent and detail-oriented Bill Review Officer to join their Operations division in Durban, KwaZulu-Natal. This is a 12-month Fixed Term Contract role, offering a competitive salary of R434,656.00 per annum. The position is also targeted for individuals with disabilities, aligning with the RAF’s commitment to inclusivity and equal opportunity.

The primary purpose of this role is to review and audit medical bills submitted to the RAF, ensuring compliance with the Road Accident Fund Act and RAF guidelines. The successful candidate will play a critical role in curbing fraudulent claims, reducing healthcare costs, and ensuring timely payments to service providers.

Role Responsibility:

The Bill Review Officer will be responsible for a wide range of tasks, including but not limited to:

Audit & Review Medical Bills:
- Conduct line-by-line analysis of claimed items/services.
- Match services with appropriate tariffs, ICD-10, and CPT-4 codes.
- Flag rejected items/services and provide recommendations for payment processing.
- Ensure accounts comply with RAF guidelines and the Road Accident Fund Act.
Fraud Prevention & Cost Management:
- Assess and monitor claims to prevent over-servicing, abuse, and fraudulent activities.
- Analyze trends in service utilization to reduce future healthcare costs.
- Compare outcomes and costs of different therapeutic modalities and surgical techniques.
Stakeholder Engagement:
- Promote positive relationships with stakeholders, including the Department of Health and other government entities.
- Provide training on new developments and updates in medical billing and tariffs.
Payment Processing:
- Check and approve payment requests for accuracy and correctness.
- Inform service providers of payment decisions in a timely manner.
Technical Assistance:
- Assist in the technical aspects of bill review, including preauthorization of procedures.
- Analyze medical data (e.g., Case Manager’s Reports, Clinical Records) to determine the necessity of services.
Operational Efficiency:
- Ensure accounts are paid according to service level agreements.
- Conduct timeous assessments of urgent files, such as those from Road Shows.

Effective Management of Staff:

While this role does not directly involve managing a team, the Bill Review Officer will collaborate closely with various departments, including finance, legal, and healthcare providers. Effective communication and teamwork are essential to ensure seamless operations and compliance with RAF standards.

Effective Management of Operations:

The Bill Review Officer will play a key role in maintaining the operational efficiency of the RAF’s billing and payment processes. This includes:

Ensuring all medical bills are reviewed and processed accurately and timeously.
Implementing strategies to reduce fraudulent claims and over-servicing.
Analyzing data to identify trends and improve cost-effectiveness.

Effective Management of Business Development Function:

Although this role is primarily operational, the Bill Review Officer will contribute to the RAF’s broader mission by:

Identifying opportunities to improve billing processes and reduce costs.
Providing insights into healthcare trends that can inform future policies and strategies.
Supporting the RAF’s commitment to road safety and victim support through efficient and ethical billing practices.

The Ideal Candidate:

The RAF is looking for a highly skilled and motivated individual with the following qualifications and attributes:

Qualifications:
- Bachelor’s Degree or Advanced Diploma in Nursing, Allied Health Professions, or a related field.
- Registration with the relevant Health Professional Council.
Experience:
- Minimum of 3 years’ experience in a medical field, preferably in billing or claims management.
Technical Competencies:
- Proficiency in computer literacy and data analysis.
- Ability to interpret UPFS tariffs and medical coding systems (ICD-10, CPT-4).
Behavioral Competencies:
- Strong analytical and organizational skills.
- Excellent decision-making and negotiation abilities.
- High emotional intelligence and personal mastery.
- Commitment to ethics, governance, and customer focus.

Skills and Attributes:

Analytical Thinking: Ability to analyze complex medical data and billing information.
Attention to Detail: Ensuring accuracy in reviewing and processing claims.
Communication Skills: Effective interaction with stakeholders and service providers.
Problem-Solving: Identifying and resolving issues related to billing and claims.
Time Management: Prioritizing tasks to meet deadlines and service level agreements.

The Bill Review Officer role at the Road Accident Fund is a unique opportunity to contribute to an organization that makes a tangible difference in the lives of road accident victims. By ensuring the accuracy and integrity of medical billing processes, the successful candidate will play a vital role in promoting fairness, efficiency, and accountability within the RAF. If you have the required qualifications, experience, and passion for making a positive impact, this role is for you. Apply before the 11th of February 2025 and join the RAF in their mission to create safer roads and support those in need.

6. Administrator: IT Governance

Job Introduction:

The Road Accident Fund (RAF) is seeking a dedicated and experienced Administrator for IT Governance to join their Strategy and Transformation division in Centurion, Gauteng. This permanent role is pivotal in ensuring the organization’s IT governance policies and procedures are effectively implemented and monitored. The successful candidate will play a crucial role in aligning IT processes with organizational goals, ensuring compliance with legal and regulatory requirements, and promoting a culture of IT governance across the organization.

Role Responsibility:

The Administrator for IT Governance will be responsible for a wide range of duties, including but not limited to:

IT Governance Administrative Duties:
- Implementing IT governance policies and frameworks to ensure they meet organizational objectives and comply with legal and regulatory requirements.
- Monitoring and reporting on compliance with IT governance policies, identifying areas of non-compliance, and recommending corrective actions.
- Facilitating the IT risk management process, including risk identification, assessment, and mitigation planning.
- Coordinating with IT and business units to ensure effective implementation of IT governance practices.
- Supporting IT governance training programs to educate staff on governance policies, procedures, and best practices.
- Participating in the management of IT audits, including preparation, liaison with auditors, and implementation of audit recommendations.
- Maintaining up-to-date knowledge of industry trends, emerging IT governance frameworks, and regulatory requirements affecting the organization.
Internal and Audit Support:
- Maintaining procedural documentation for IT operations, ensuring clarity, accuracy, and accessibility for IT staff and relevant stakeholders.
- Validating alignment of process maps that visually depict IT workflows, including data flows, system interactions, and decision points.
- Implementing and maintaining IT governance frameworks (such as COBIT, ITIL, or ISO/IEC 27001), ensuring IT processes are aligned with organizational goals and compliance requirements.
- Working with internal and external auditors to provide required documentation and evidence of IT processes and controls.
- Assisting in addressing audit findings and implementing recommended changes.
- Collaborating with IT teams and business stakeholders to gather information on existing procedures and requirements for new processes.
- Conducting analysis to ensure that documentation meets the needs of end-users and supports training efforts.
- Monitoring current processes and documentation for improvement opportunities.
- Facilitating process improvement initiatives in collaboration with IT teams.
- Identifying and documenting potential risks associated with IT processes.
- Contributing to the development and implementation of risk mitigation strategies.
- Creating and maintaining training materials based on documented procedures and processes.
Reporting:
- Contributing to the preparation of reports for senior management and external regulators, highlighting the status of IT governance initiatives.
- Contributing to the preparation of regular IT Governance reports, compiling data for senior management and technical teams.
Stakeholder Management:
- Supporting the facilitation and management of communications with relevant internal stakeholders on IT Governance matters, under the guidance of the Seniors and ICT Management.
- Providing assistance to IT operational staff regarding the maintenance of the Internal Control system.

Effective Management of Staff:

The Administrator for IT Governance will be expected to lead by example, fostering a culture of accountability, collaboration, and continuous improvement within the IT Governance team. This includes providing guidance and support to team members, ensuring that they are well-equipped to perform their duties effectively.

Effective Management of Operations:

The role requires a proactive approach to managing IT governance operations, ensuring that all processes are aligned with organizational objectives and regulatory requirements. This includes regular monitoring and evaluation of IT governance practices, as well as the implementation of necessary improvements to enhance efficiency and effectiveness.

Effective Management of Business Development Function:

The Administrator for IT Governance will also play a key role in supporting the organization’s business development function by ensuring that IT governance practices are aligned with business objectives. This includes collaborating with business units to identify opportunities for improvement and implementing strategies to enhance the overall effectiveness of IT governance.

The Ideal Candidate:

The ideal candidate for this role will possess the following qualifications and experience:

A Bachelor’s Degree or Advanced Diploma in Information Systems, Computer Science, Risk Management, Internal Audit, or related qualifications.
Certifications in IT governance frameworks (e.g., COBIT, ITIL, ISO/IEC 27001) will be an added advantage.
A minimum of 3 years of relevant experience in an IT Governance, Risk Management, or IT Compliance environment.
Experience with IT audits and the implementation of IT governance frameworks and standards.

Skills and Attributes:

Strong analytical and problem-solving skills.
Excellent communication and interpersonal skills.
Ability to work collaboratively with cross-functional teams.
Strong organizational and time management skills.
Attention to detail and a commitment to accuracy.
Ability to adapt to changing priorities and work under pressure.
Knowledge of industry trends and emerging IT governance frameworks.

The Administrator for IT Governance role at the Road Accident Fund is a challenging and rewarding opportunity for a skilled professional to make a significant impact on the organization’s IT governance practices. If you meet the qualifications and possess the necessary skills and attributes, we encourage you to apply before the closing date on 11 February 2025.

7. Consultant: Medical Management

Job Introduction:

The Road Accident Fund (RAF) is a pivotal organization in South Africa, dedicated to providing comprehensive cover to all road users within the country. Its mission extends to rehabilitating and compensating individuals injured in motor vehicle accidents promptly and compassionately, while also advocating for safer road usage. The RAF is currently seeking a Consultant: Medical Management to join its Operations division in Menlo Park, Gauteng. This fixed-term contract role is crucial in implementing medical management activities, handling medical exceptions, and supporting claims processing administration.

Role Responsibility:

The Consultant: Medical Management will be tasked with a variety of responsibilities aimed at ensuring the efficient and effective management of medical claims. Key responsibilities include:

Medical Management:
- Conducting medical assessments and compiling detailed injury assessment reports.
- Reviewing submitted claims and bills, focusing on the appropriateness of care, length of stay, and quality of care.
- Ensuring adherence to RAF tariffs, cost-saving initiatives, and treatment protocols.
- Pre-authorizing claims in line with RAF clinical guidelines, including the RAF formulary and treatment protocols.
- Escalating complex cases for multi-disciplinary review and adjudication.
- Participating in consultations to implement medical claims processes.
Exception Handling:
- Implementing and maintaining a formal exception handling process within medical management.
- Documenting and regularly updating the exception handling process.
- Managing unusual occurrence procedures.
Reporting:
- Tracking and reporting against set objectives and targets.
- Reporting on emerging risks.
- Providing ad-hoc reports on process improvement initiatives.
- Producing documents, briefing papers, reports, and presentations.
Stakeholder Management:
- Dealing with and responding to correspondence.
- Maintaining healthy relationships with all stakeholders.
- Following up and making recommendations on corrective actions.
- Providing feedback to stakeholders on the status of queries.
- Responding to queries within predefined turnaround times.

Effective Management of Staff:

The Consultant: Medical Management will play a vital role in leading and guiding a team of professionals. This involves:

Providing clear direction and support to staff.
Ensuring that team members are adequately trained and equipped to perform their duties.
Fostering a collaborative and productive work environment.

Effective Management of Operations:

Operational efficiency is paramount in this role. The Consultant will:

Oversee the day-to-day operations of medical management activities.
Ensure that all processes are aligned with RAF guidelines and standards.
Implement best practices to enhance operational effectiveness.

Effective Management of Business Development Function:

The Consultant will also contribute to the business development function by:

Identifying opportunities for process improvements and cost savings.
Developing and implementing strategies to enhance service delivery.
Collaborating with other departments to achieve organizational goals.

The Ideal Candidate:

The ideal candidate for the Consultant: Medical Management position will possess a combination of qualifications, experience, and personal attributes that align with the demands of the role.

Qualifications and Experience:

A Bachelor’s Degree or Advanced Diploma in Health Sciences or a related medical field.
Registration with the Health Professions Council of South Africa (HPCSA) or the South African Nursing Council (SANCA).
A minimum of three years of relevant experience in a medical-related environment.

Technical Competencies:

Proficiency in claims management processes and systems.
Expertise in medical product management.
Skilled in medical bill reviewing and case management.

Behavioural Competencies:

Strong planning, organizing, and coordinating abilities.
Personal mastery and a commitment to continuous learning.
Sound judgment and decision-making skills.
High ethical standards and values.
A strong client service orientation.

Skills and Attributes:

Excellent communication and interpersonal skills.
Analytical thinking and problem-solving abilities.
Attention to detail and a high level of accuracy.
Ability to work under pressure and meet deadlines.
Strong leadership and team management skills.

The Consultant: Medical Management role at the Road Accident Fund is a challenging yet rewarding opportunity for a qualified and experienced medical professional. The successful candidate will play a crucial role in ensuring the effective management of medical claims, contributing to the RAF’s mission of providing timely and compassionate support to road accident victims. If you meet the qualifications and possess the necessary skills and attributes, we encourage you to apply before the closing date of 11 February 2025. Join us in making a difference on South Africa’s roads.

Click Here to apply

We wish nothing but the best in your applications

February 4, 2025 admin@shoshanews.co.za

1. Officer: Legal Administration (x15)

2. RAF Attorney: High Court

3. Consultant: Medical Management x5

4. Senior Officer: Field Case Management x4

5. Officer: Bill Review x2

6. Administrator: IT Governance

7. Consultant: Medical Management

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