Reporting to the Senior Risk Health and Wellness Officer
The main responsibilities of the job are:
Case Management.
Claims Reviews & Investigations.
Risk Management & Wellness.
Provider Network Management
Quality Assurance and Compliance.
Qualifications:
- Degree in Nursing.
- Diploma in Theatre nursing and/or midwifery is an added advantage.
- Insurance and Risk Management OR equivalent is an added advantage.
Ideal Candidate must:
- Have 3 years’ experience in claims investigations, case management and implementation of wellness programmes in a medical aid environment.
- Possess excellent investigative, problem solving and decision making skills.
- Have a strong client focus.
- Have good written and verbal communication skills.
- Be a person of integrity who is transparent and able to observe and protect the confidential nature of information.