client operating in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their hospital nursing experience. Previous exposure to clinical auditing is highly advantageous. Be available Responsibilities Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization)
located in Johannesburg North is looking for a Clinical Auditor to join their team Minimum Education: nurse) Minimum Experience: 3 to 5 years (previous clinical auditing experience in a managed healthcare environment limited to the following: Knowledgeable of the Medical Schemes Act and Government Gazette on tariffs Vet accounts under the guidance of the gazette Use clinical guidelines and protocols when vetting accounts accounts for technical correctness using sound medical judgement Reconcile hospital accounts Deal with
Position: Medical R&D Specialist Location: JHB Industry: Re-Insurance REF: MVG/MR&D Re-insurance Re-insurance client is seeking a medically qualified incumbent passionate about leveraging research and development quantify the effects of health technologies and clinical advancements on mortality and morbidity at a population within a medical insurance, life insurance, or managed care environment Advantageous: Medical degree,
located in Johannesburg North is looking for a Clinical Auditor to join their team Minimum Education: nurse) Minimum Experience: 3 to 5 years (previous clinical auditing experience in a managed healthcare environment limited to the following: Knowledgeable of the Medical Schemes Act and Government Gazette on tariffs Vet accounts under the guidance of the gazette Use clinical guidelines and protocols when vetting accounts accounts for technical correctness using sound medical judgement Reconcile hospital accounts Deal with
client operating in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their hospital nursing experience. Previous exposure to clinical auditing is highly advantageous. Be available Responsibilities Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization)
Position: Medical R&D Specialist Location: JHB Industry: Re-Insurance REF: MVG/MR&D Re-insurance Re-insurance client is seeking a medically qualified incumbent passionate about leveraging research and development quantify the effects of health technologies and clinical advancements on mortality and morbidity at a population within a medical insurance, life insurance, or managed care environment Advantageous: Medical degree,
Clinical Risk Management Specialist Industry: Insurance Location: Cape Town Type: Hybrid (3 In/ 2 Out) seeks to employ a Clinically qualified individual to assist within their Clinical Risk Management team of the role is to assess the risk profiles of medical practitioners within the company's broad underwriting Provide clinical leadership and support. Analyze research data. Requirements : Registered medical practitioner the relevant council. Proven underwriting and clinical risk management working experience within Managed
Processing Processing of all cash, credit card, and medical aid receipts in the cashbooks. Processing of all Daily reconciliation of all clinic receipts/banking (cash, yoco and medical aid receipts) Daily reconciliations reconciliations of pharmacy inventory for all clinics (inventory receipts, issues, and balances.) Weekly reconciliation Check all medical aid claims are loaded on Health Bridge and correctly submitted. Call Medical Aid in respect status of claims. Follow-ups on payments due from Medical Aids. Follow-ups on rejected payments and resubmit
Processing Processing of all cash, credit card, and medical aid receipts in the cashbooks. Processing of all Daily reconciliation of all clinic receipts/banking (cash, yoco and medical aid receipts) Daily reconciliations reconciliations of pharmacy inventory for all clinics (inventory receipts, issues, and balances.) Weekly reconciliation Check all medical aid claims are loaded on Health Bridge and correctly submitted. Call Medical Aid in respect status of claims. Follow-ups on payments due from Medical Aids. Follow-ups on rejected payments and resubmit
Clinical Risk Management Specialist Industry: Insurance Location: Cape Town Type: Hybrid (3 In/ 2 Out) seeks to employ a Clinically qualified individual to assist within their Clinical Risk Management team of the role is to assess the risk profiles of medical practitioners within the company's broad underwriting Provide clinical leadership and support. Analyze research data. Requirements : Registered medical practitioner the relevant council. Proven underwriting and clinical risk management working experience within Managed