Medical Triage Officer

Role Description

The Medical Triage Officer is a clinically qualified professional embedded within the Global Response Centre (GRC), with a primary mandate to provide medical case management, clinical triage, and prioritisation of medical assistance cases. The role serves as a key connection point between the Operations Team and Medical Desk, ensuring that cases requiring clinical input are appropriately identified, assessed, prioritised, and escalated to the Medical Desk in a timely and structured manner. Operating within a 24/7 international assistance environment, the Medical Triage Officer provides clinical support to GRC call agents and the Operations Team by assessing medical urgency and risk, identifying clinical red flags, interpreting medical information and documentation, and determining appropriate escalation pathways. The role supports the effective prioritisation and management of cases according to clinical complexity, acuity, and potential risk, while providing guidance to agents and facilitating communication with the Medical Desk, treating facilities, assistance providers, and other relevant stakeholders.

As a secondary responsibility, the Medical Triage Officer supports the safeguarding of Assist360 and its clients against fraudulent, wasteful, and abusive claims practices. This includes identifying potential indicators of fraud or inappropriate utilisation, conducting clinical and fraud risk assessments, supporting investigations into flagged cases, analysing medical and billing information, and contributing to claims integrity, recovery, and prevention initiatives.The Medical Triage Officer must be able to communicate confidently across diverse teams, including patients, GRC call agents, treating clinicians, insurers, and other stakeholders, while remaining calm and decisive when managing complex or high-risk cases in a fast-paced, 24/7international environment.

Qualifications

• Registered or Professional Nurse or Paramedic (current registration with the South African Nursing Council, HPCSA, or equivalent regulatory body).
• A fraud investigation qualification is advantageous. Additional qualifications in critical care, forensic auditing, or case management are advantageous.
• Minimum 3 years post-registration clinical experience (essential); minimum 2 years in medical claims review, fraud/waste/abuse (FWA) detection, or forensic claims auditing within a medical assistance, insurance, or TPA/DCA environment (advantageous).
• Strong communication skills, including clear documentation and compassionate, culturally sensitive interactions with clients.

Further Information

• Please note this is not a position for a medical doctor.
• We are looking for a Professional Nurse with a Bachelor of Nursing qualification or a Paramedic.
• For nurses, we are seeking registered nurses or professional nurses. Not enrolled nurses.
• Standard working hours are Monday to Friday, 08:00 to 17:00. It is an integral condition of
• employment that the Employee is required to be on standby every second week, as follows: Monday to Friday: 17h00 to 08h00. Saturday and Sunday: 24 hours per day