Clinical Claims Ajudicator at Rand Mutual - RMA

Job description

• To effectively and efficiently process Compensation for Occupational Injuries and Diseases claims, as well as other RMA non statutory claims
• Medical Management of Severe Injury claims (those which will result in PD Lump Sums and Disability Pensions)
• Management and Review of Medical Reports
• Medical Management
• Ensure Timeous Finalization of Claims
• Training and Liaison with Medical Service Providers/Follow-up with Medical Service Providers on outstanding medical reports
• Training/Coaching of staff in the Branch
• Manage workflows escalated from Senior Claims Assessor or any other Branch Role
• Management of TTD Claims
• Stakeholder Liaison

Desired Skills and Experience

• Matric (including Maths / Accounting)
• Degree/Diploma in :-Nursing / Medical
• Medical Knowledge at NQF6 level
• Knowledge of administrative and clerical procedures
• Computer literate - MS Office
• Numerate
• Knowledge of Customer Service principles and practices
• Valid Driver's License and own transport
• At least 4 years industry experience within the Managed Healthcare Sector
• Excellent numeracy skills
• Building customer loyalty
• Contributing to team success
• Managing work and time management
• Stress tolerance
• Decision making