Claims Administrator - Medical Aid

Placements24; East London; Presencial; ZAR 180 000 - 240 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Medical aid contributions

Provident fund

On-the-job training

Staff wellness programs

Resumo da oferta

Placements24 in East London is seeking a diligent Claims Administrator to join our busy operations team. The role focuses on processing medical aid claims accurately and ensuring timely payments to providers and members.

You will verify eligibility, apply correct coding, maintain records, and collaborate across departments to resolve queries. This office-based position offers stability and a supportive environment in the Eastern Cape.

Qualificações

• A minimum of 2 years of experience in processing medical aid claims.
• Good understanding of medical coding (ICD-10, CPT) and healthcare billing practices.
• Proficiency in using medical claims processing software and Microsoft Office Suite.
• Must be based in or willing to relocate to East London, Eastern Cape.

Responsabilidades

• Process medical aid claims from members and healthcare providers accurately and in accordance with scheme rules and policies.
• Verify patient eligibility and benefits coverage for each claim submitted.
• Ensure correct coding and billing information is used for claim processing.
• Identify and investigate discrepancies or potential issues with claims, escalating when necessary.
• Communicate with members, healthcare providers, and other departments to resolve claim queries.
• Maintain accurate and up-to-date records of claims processed and payments made.
• Adhere to turnaround times and service level agreements for claim processing.
• Assist in identifying trends or patterns in claims that may indicate fraud or abuse.
• Ensure compliance with all relevant medical aid regulations and internal procedures.
• Participate in team meetings and contribute to process improvement initiatives.

Conhecimentos

Attention to detail

Organizational skills

Communication skills

Teamwork

Time management

Confidentiality

Ethical standards

Formação académica

High School Diploma or equivalent

Medical Terminology or Health Administration qualification (advantageous)

Ferramentas

Medical claims processing software

Microsoft Office Suite

Descrição da oferta de emprego

About the Role

Our client, a reputable medical aid provider, is seeking a diligent and organised Claims Administrator to join their busy operations team in East London, Eastern Cape . This role is responsible for processing medical claims accurately and efficiently, ensuring timely payments to healthcare providers and members. You will play a vital role in maintaining member satisfaction and upholding the integrity of the claims process. This is an office-based position, offering a stable and collaborative work environment in East London .

Key Responsibilities

• Process medical aid claims from members and healthcare providers accurately and in accordance with scheme rules and policies.
• Verify patient eligibility and benefits coverage for each claim submitted.
• Ensure correct coding and billing information is used for claim processing.
• Identify and investigate discrepancies or potential issues with claims, escalating when necessary.
• Communicate with members, healthcare providers, and other departments to resolve claim queries.
• Maintain accurate and up-to-date records of claims processed and payments made.
• Adhere to turnaround times and service level agreements for claim processing.
• Assist in identifying trends or patterns in claims that may indicate fraud or abuse.
• Ensure compliance with all relevant medical aid regulations and internal procedures.
• Participate in team meetings and contribute to process improvement initiatives.

Requirements

• A High School Diploma or equivalent is required; a qualification in Medical Terminology or Health Administration is advantageous.
• A minimum of 2 years of experience in processing medical aid claims, preferably within a medical aid scheme or administrator.
• Good understanding of medical coding (e.g., ICD-10, CPT) and healthcare billing practices.
• Proficiency in using medical claims processing software and Microsoft Office Suite.
• Strong attention to detail and accuracy in data entry and processing.
• Excellent organizational and time management skills.
• Good communication and interpersonal skills, with a patient-focused approach.
• Ability to work effectively both independently and as part of a team.
• A commitment to maintaining confidentiality and ethical standards.
• Must be based in or willing to relocate to East London, Eastern Cape for this full-time, office-based role.

Benefits

• Our client offers a competitive entry-level salary, along with benefits such as medical aid contributions and a provident fund.
• This role provides a fantastic opportunity for individuals looking to build a career in the healthcare administration sector.
• You will receive comprehensive on-the-job training and the support of an experienced team in East London .
• Opportunities for professional growth and development within the organization are available.
• Additional benefits may include performance incentives and staff wellness programs.