A well-established company specialising in the administration of injury on duty claims requires an Assistant Production Manager to assist in managing the production division and staff, overseeing daily operations (capturing, interpreting, processing and adjudicating of medical claims related to injury on duty), manage targets and provide training and feedback to clients.
• The candidate must be able to directly manage and supervise production staff members;
• The candidate must have background knowledge of the production management subject area;
• The candidate must ensure that they are familiar with and gain full knowledge of the Compensation for Occupational Injuries and Diseases Act (COIDA);
• The candidate must have experience in the Medical Services claims industry and knowledge of legislation regulating the industry;
• The candidate must have sufficient medical background to be able to assist with client enquiries and the adjudication of difficult cases where specialist knowledge is required; and
• The candidate must gain a full understanding of the processes, procedures and systems used in the execution of the company’s core operations.
• Assist with the management of production staff;
• Oversee daily operations of medical invoice processing and adjudication of claim payments to medical service providers;
• Ensure that all production processes and procedures are well documented and communicated;
• Ensure that all procedures are followed and that all production goals are met;
• Train and develop staff members, with the aim of continued improvement and optimisation of resources;
• Provide medical advice and/or direction on claims to staff members;
• Following up on outstanding information required from clients and employers for processing of medical claims and invoices;
• Provide on-site training and assistance to clients;
• Resolve enquiries from clients related to the COID Act and medical treatment of patients;
• Assist clients with case managing seriously injured patients;
• On an ad-hoc basis liaise with members of the Compensation Fund;
• Manage the submission of queries to the Medical Services division at the Compensation Fund; and
• Contribute to daily operations.
• Excellent communication (verbal and written), interpersonal and training skills are essential;
• Management skills and experience;
• Drivers licence and own transport;
• Computer literate in Microsoft Excel, Word and PowerPoint;
• Tertiary Nursing qualification;
• Member of the South African Nursing Council (SANC);
• COIDA knowledge;
• COIDA medical tariff knowledge;
• ICD10, CPT and NAPPI code knowledge.