Job Summary
Core Purpose
The core purpose of the role is to enhance the management of the Scheme's clinical risks and ensure cost-effective use of benefits by providing clinical expertise and aiding in the creation of industry-standard guidelines. This role supports the holistic member-centric care within the Managed Care division, in accordance with Scheme rules and legislation.
Requirements
Medical doctor registered with the Health Professions Council of South Africa.
Knowledge of medical coding will be an advantage.
At least five years’ operational experience, including managed care experience.
Sound knowledge of the Medical Aid industry, rules and regulations, and other related legislation, including PMB guidelines.
Key Competencies
Clinical expertise, oversight, and guidance.
Ability to convey complex medical information to diverse audiences.
Time management and good administration skills.
Strong team player and results-driven.
Able to perform well under pressure.
Business insights.
Good problem-solving skills.
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