Employer:The Rand Mutual Assurance Company Limited
Location: Gauteng
We offerR221k R459k pa
Applications are invited by The Rand Mutual Assurance Company Limited (RMA), for the Clinical Claims Adjudicator position at the Carletonville Branch
DescriptionAs a Clinical Claims Adjudicator you will be responsible for the following:
• Data Capturing
• Claims Management -
o Management of Severe Injury claims (those which will result in a PD Payment / Disability Pension / Fatal Claim)
o The adjudication of all NIHL claims, including the calculation of the PD, for sign off by the Regional Medical Manager
o Management of claims in terms of RMA MMI
o Ensure that all scanned documentation has been indexed accurately
o Accept workflowed escalated from Claims Assessor
o Follow ups on all open claims - with MSP / Doctor /Employer / Injured
i Earnings
ii Banking Details
iii Questionnaires
o The loading on Banking details
o Appointment of tracing agents in fatal claims including regular follow ups
o Review of claims estimates in line with prescribed limits
o Identification of potential recovery claims
o Claims to be finalised within the RMA Maximum Medical Improvement
• Management of Medical Reports
o Capture and/or accept medical reports
o Updating of ICD10 codes
• Management of TTD claims
o Acceptance and/or capturing and payment of TTD claims =/<365days, within 15 days of date of receipt
o Ensure that all TTD claims are supported by a valid medical report
• Management of the Timeous Finalisation of Claims
o Where relevant, extend RMA MMI to authority limits
o Calculation of disability assessment - workflowed from the SCA for electronic sign off
• Management of medical authorisations
o Pre authorisations in the "acute phase" with respect to consultations, scripts and follow up visits
o Follow up on outstanding medical reports
• Internal Audit
o Adherence to Company Standard Operating Procedures
ProfileEducational Requirements:
• Grade 12 ( Including maths / accounting )
• Degree in Medical ( Paramedics / nurse )
• Computer literacy : Advanced MS Word, Excel and Outlook
Competencies:
• Applied Learning
• Building Customer Loyalty
• Contributing to Team Success
• Managing Work (Includes Time Management)
• Initiating Action
• Stress Tolerance
• Decision Making
Essential Criteria:
• Multilingual
• Good Administrative skills
• Good computer literacy skills
• Good communication skills, verbal and written
• Ability to work under pressure, be target driven and meet deadlines
• At least 4 year industry related experience
• Valid Driver's Licence and own transport
Apply
