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Enterprise Risk Practitioner
1 day ago
Six Sense Pretoria, South AfricaGauteng, Tshwane (Pretoria) · - Annually Cost To Company (Market related) · A well-established public entity is seeking to appoint a Enterprise Risk Practitioner · Enterprise Risk Practitioner will assist the Enterprise Risk Manager in the design, implementation, and management o ...
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Specialist Clinical Auditor
1 week ago
H2R Africa Pretoria, South Africavalid registration with SANC. Also financial background working in the accounts department of a hospital is a crucial requirement. · Minimum 2 years experience working within a private hospitals account department responsible for raising accounts with and billing medical schemes. ...
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Senior Manager: Actuarial Services
2 days ago
Tych Business Solutions Pretoria, South Africa**Key Performance Areas (KPAs)**: · - Establish and oversee the Actuarial capabilities in the organisation · - Provide accurate monthly and annual forecasts with appropriate well considered analysis and risk adjustments. · - Identify and communicate cost efficiency opportunities ...
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Senior Manager
1 week ago
Tych Business Solutions Pretoria, South Africa**Job ID**: 85358**Date Posted**: Posted 6 hours ago**Location**: Pretoria**Job Title**: SENIOR MANAGER (ACTUARIAL SERVICES) - PRETORIA - GAUTENG · Key Performance Areas (KPAs): · - Establish and oversee the Actuarial capabilities in the organisation · - Provide accurate monthly ...
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Clinical Auditor
1 week ago
Careforce Recruitment Pretoria, South AfricaPosition: Specialist Clinical Auditor · Reporting to: Senior Specialist Clinical Management · Location: On-site at the Head Office, Pretoria · **Purpose of the position**: · Clinical Auditors are responsible to ensure that medical facilities like hospitals, and other healthcare s ...
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Manager: Facilities Management
1 week ago
Construction Education & Training Authority Midrand, South Africa**JOB PURPOSE AND PROFILE** · To ensure the development, enhancement, communication, reporting and oversight of the CETA's Facilities Management strategy and framework and associated tools and processes, ensuring that these are supportive of the CETA strategy and mitigate busines ...
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Administrator: Od and Talent Management
1 week ago
Construction Education & Training Authority Midrand, South Africa**JOB PURPOSE AND PROFILE** · To provide administrative support to the Organisational Development & Talent Management unit to ensure the effective and efficient running of the office, provide superior service and to support the CETA in the execution of the overall strategy. · **R ...
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Receptionist
2 days ago
Construction Education & Training Authority Midrand, South Africa**JOB PURPOSE**: · To act as the first point of contact for visitors and callers to alert and to undertake a range of other administrative tasks as identified by the Manager: Marketing, Communications & Stakeholder Management. · **RESPONSIBILITIES**: · - Maintain and ensure that ...
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stores manager – packaging
3 days ago
MPRTC Sandton, South AfricaRequired skills:Excel proficiency · Knowledge of OSHA regulations · Familiarity with SAP for inventory management · Understanding of warehouse procedures and inventory management systems · Needed Experience:Oversight of storage areas · Maintenance of warehouse equipment · Impleme ...
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renewable energy efficiency electrician
3 days ago
MPRTC Sandton, South AfricaWhat you'll do:Perform comprehensive efficiency audits in residential, commercial, or industrial settings, identifying areas for energy waste and potential savings. · Conduct thorough meter audits, ensuring accuracy and proper functioning of electrical meters. · Install and progr ...
Fraud Waste - Pretoria, South Africa - CATALYST RECRUITMENT SHUMA BCCATALYST RECRUITMENT SHUMA BC
Description
Work experience
At least 2 - 3 year's experience in processing claims . 1 Year experience in forensic/investigative claims assessing or dealing with fraud, waste and abuse claims in a medical scheme .
Requirements:
Knowledge related to the industry will be a requirement. Experience in claims assessing and the understanding thereof. An understanding of claims processing system (expected within 3 months). Understanding and knowledge of Medical Scheme Rules/compliancy. Proven working experience, persistence to obtain case information not readily available and ability to work independently with minimum supervision. Extraction of reports, identification of "codes" to investigate/identify fraud, waste and abuse claims and submission of claim reports with updates on traction. Detect and safeguard the financial integrity of the scheme and minimize losses pertaining to fraud, waste and abuse claims.
Educational Requirements:
Grade 12. Computer Literacy * Intermediate. Typing skills * Accuracy. Post matric qualification- Diploma in healthcare administration or related field desirable. Certificate in Business Administration (Advantageous)