Consultant: IOD Recoveries

Key Responsibilities:

• Analyse IOD claims to verify medical expenses and identify potential recoveries
• Submit and monitor IOD claims with SAPS and relevant administrators
• Prepare detailed reports on claims trends, recovery tracking, and issue escalation
• Ensure all information is verified, completed, and submitted accurately and on time
• Maintain relationships with SAPS, members, providers, and administrators

Requirements:

• NQF Level 7 Nursing Qualification
• SANC Registration
• 4+ years of experience in:
  
  • Medical Third Party Claims
  • Administration Services
  • Case Management in medical schemes
• Experience in ICD10/CPT coding
• Proven ability to manage third-party processes and resolve escalations

Skills & Competencies:

• Claims and recoveries management
• SAPS liaison and provider engagement
• Report writing, auditing, and case analysis
• Strong ethics, compliance, and governance focus
• Collaboration, communication, and accountability