Case Manager Managed Healthcare - Johannesburg

LetsLink Medical Recruitment Agency is assisting one of the leading health insurance product providers in South Africa to recruit a Case Manager.

Requirements:
Matric
Registered Nursing diploma
Valid membership of SANC
Claims and Forensic Risk management certification
Registration with the Association of Certified Fraud Examiners (ACFE SA)


Skills and experience:
At least 2-3 years’ experience in a similar role.
MIP Application System experience and advantage.
Sound understanding of the South African Health Industry, benefits, and options, etc.
ICD codes, modifiers, and RPL tariff knowledge and understanding.
Ability to liaise with external parties – clinicians and members.
Ability to work within an established team.
Excellent oral and written communication skills.
Customer-centric attitude.
Excellent analytical skills and pays attention to detail.
Computer literate - MS Office suite, i.e., Word, Excel.
A good understanding of claims risk profiling.
Experience in claims auditing.
Location: Johannesburg Gauteng

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