Medical Advisor

- Provide clinical support to medical review, PMB, chronic illness benefit, hospital and oncology case management, underwriting and forensics teams.

- Ensure workflow pools and turnaround times are met.

- Participate in key clinical forums internally and externally.

- Run daily clinical review: prepare and present cases, load member remarks and clinical exceptions, arrange second opinions and follow up.

- Communicate funding decisions to relevant parties.

- Keep abreast of legislative, industry and clinical developments and attend CPD events.

- Identify new medical industry trends and engage clinical stakeholders.

- Build relationships with external healthcare providers.

- Maintain a database of funding decisions.

- Support junior staff and other medical advisors.

- Apply claims and coding knowledge to resolve payment issues.

- Identify operational gaps and initiate improvement strategies.

- Matric.

- Qualified Medical Doctor with full and current HPCSA registration for Independent Practice.

- Minimum of two years' experience in a private hospital or clinic.

- Previous Medical Advisor or managed healthcare experience advantageous.

- Clinical coding knowledge of ICD-10 advantageous.

- Knowledge of the managed care environment and Prescribed Minimum Benefits.

- Excellent written and verbal English communication.

- Basic Microsoft Office literacy; proficient in Excel.