Registered Nurse Clinical Auditor

About the position

Job Title: Registered Nurse Clinical AuditorCompany: Managed Care OrganizationLocation: JHBType: Full-time (On-site)Ref: MVG/CA Position Purpose:Seeking a highly qualified Registered Nurse to join our client's Provider Relations division. The primary focus will be managing and investigating fraud cases in collaboration with the Special Investigations team, while ensuring that cases are resolved promptly and reports are submitted as needed. Key Responsibilities:

• Investigate fraud cases flagged by the Fraud Forum, following guidance from relevant stakeholders.
• Prepare and submit internal and external case reports to management and the Scheme.
• Resolve issues according to company procedures and escalate when necessary.
• Handle additional projects related to the Service Provider Network environment as required.
• Attend Fraud Forum meetings and workshops, providing feedback to the team.
• Conduct comprehensive investigations of cases, including provider claim profiles.
• Ensure quality control of all information received from internal teams and external Service Provider Networks.
• Maintain strict confidentiality of all sensitive information.

Qualifications & Experience:- Registered Nurse with 3-4 years of relevant nursing experience in the private healthcare sector.- Previous experience in Clinical Auditing or Clinical Claims Assessing is essential.- Prior Case Management background with progression into Clinical Auditing preferred- CFE certification is highly advantageous

Skills & Attributes:- Strong investigative and analytical skills.- Ability to handle confidential information with discretion.- Excellent communication and report-writing abilities.- Ability to work under pressure and meet deadlines.

How to Apply:Please send your updated CV and supporting documents to [Email Address Removed]. MVG/CA Supporting documents:- Comprehensive Word CV- Copy of Nursing Degree/ Diploma- Copy of Post Basic Qualification- Copy of current SANC registration (2025)

Desired Skills:

• Registered Nurse with 3-4 years of relevant nursing experience in the private healthcare sector.

Desired Work Experience:

• 2 to 5 years

Desired Qualification Level:

• Diploma