Claims Administrator

Clicks Group Limited

Roodepoort

On-site

ZAR 134,000 - 201,000

Full time

31 hours ago

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Job summary

Clicks Group Limited seeks a claims support professional in Gauteng to resolve medical aid rejection queries and coordinate corrective actions with members and schemes. You will work toward timely authorisations and provide status updates on resolutions.

The role emphasizes rapid turnarounds and requires knowledge of Unisolv/Marconi platforms, formularies, and pharmacy regulations, with strong analytical and interpersonal skills to support patients and providers.

Qualifications

Analytical mindset and problem-solving abilities.
Ability to coordinate corrective actions for medical aid rejections.
Knowledge of medical aid formularies and pharmacy regulations.

Responsibilities

To resolve medical aid rejection queries with members where medical aid has no impact e.g. benefit exceeded.
To resolve medical aid rejection queries with medical scheme e.g. medication authorization.
To provide member with status update regarding rejection and resolution thereof.
To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical aid three days prior to due date of delivery.
To resolve queries received from patients within a two hour turn-around time e.g. extended supplies due to member going oversees.

Skills

Analysing

Deciding & Initiating Action

Adhering to Principles and Values

Persuading and Influencing

Working with People

Adapting and Responding to Change

Delivering Results

Following Instructions

Applying Expertise

Meeting Customer Expectations

Education

IT applications areas and delivery channels (Unisolv and Marconi)

Medical Aid Formularies (6 months)

Product knowledge (1 year)

Pharmacy Council Legislation (1 year)

Job description

To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections by corrective action.

Job Objectives:

To resolve medical aid rejection queries with member where medical aid has no impact e.g. benefit exceeded.

To resolve medical aid rejection queries with medical scheme e.g. medication authorization.

To provide member with status update regarding rejection and resolution thereof.

To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical aid three days prior to due date of delivery.