Job Description

• Review the case-note of clients in assigned hospitals, to ensure that the treatment provided aligns with the in-house coverage determination criteria.
• Escalate and document any claim(s) that are fraudulent, waste or appear to be abuse of insurance principles.

Job Specification

• Candidate must be a Registered Nurse (RN), Registered Midwife (RM), or holder of BSc nursing First (BScN) Degree
• Must be resident in the states required for the role
• 1-2 years of practical working experience in the capacity of a case auditor is compulsory
• Proven track record of performance in Auditing case notes.
• Ability to work in a team.
• Ambitious and target focussed with a drive to succeed.