CLAIMS ASSESSOR

Bestmed; Pretoria; On-site; ZAR 240,000 - 360,000; Full time

Job summary

Bestmed in Pretoria is seeking a detail-oriented Claims Assessor to accurately assess and process member claims in line with benefit and tariff structures. You will apply policy rules to each claim, ensuring correct, timely payment while upholding accuracy, compliance, and service standards.

Key responsibilities include applying appropriate rules, maintaining quality, meeting production and department targets, and supporting efficient claims administration.

Qualifications

• Grade 12 or equivalent.
• Minimum 2 years of claims assessing experience in the Medical Aid industry.

Responsibilities

• Assess claims using the applicable rules and tariffs.
• Ensure timely and correct payment in line with policies.
• Maintain quality and meet operational targets.

Skills

Attention to detail

Analytical thinking

Claims processing

Customer service

Education

Grade 12

Job description

Introduction

We are seeking a detail-oriented and analytical Claims Assessor to ensure that all claims are accurately assessed and processed in accordance with Bestmed’s benefit and tariff structures. The successful candidate will apply the relevant rules and guidelines to each claim, ensuring correct and timely payment while maintaining accuracy, consistency and compliance. This role plays an important part in supporting efficient claims administration and delivering a high standard of service to members and providers.

Duties & Responsibilities

The purpose of this position is to ensure that all claims are assessed using the appropriate rules and is paid correctly in line with the Bestmed benefit and tariff structures.

• Quality

• Production

• Operational and Department targets

Desired Experience & Qualification

Qualification

• Grade 12

Experience

• Minimum 2 years claims assessing experience in the Medical Aid industry