Claims Assessor ( Gap Cover)

Moladira Skills; Johannesburg; On-site; ZAR 200,000 - 300,000; Full time

Job summary

A leading company in the healthcare insurance sector is seeking a Claims Assessor to accurately capture and process paper Gap claims. The ideal candidate will have 3 years of relevant experience in claims processing and a solid understanding of healthcare legislation. This role offers an opportunity to contribute to operational excellence and customer service in a dynamic environment.

Qualifications

• 3 years relevant healthcare industry experience.
• Experience in short term insurance and claims processing.

Responsibilities

• Capture and process gap claims accurately.
• Maintain compliance with legal and regulatory standards.
• Investigate and resolve claims while ensuring client satisfaction.

Skills

Problem solving

Business writing

Communication

Attention to detail

Customer focus

Multitasking

Analytical skills

Education

Matric

RE5

Tools

Microsoft Office

Job description

CLAIMS ASSESSOR (Gap Cover)

Position Purpose: To ensure that all paper Gap claims are accurately captured into the iMed system.

Experience: 3 years relevant healthcare industry, short term insurance, and credit data capturing and claims processing experience.

Qualifications: Matric and RE5 Required.

Accountabilities:

• Client service delivery and quality: Follow procedures and cooperate with peers and leader for best possible service delivery.
• Compliance and Risk Management: Maintain defined legal, statutory, and regulatory compliance; adhere to operational risk and governance frameworks.
• Financial Management: Contribute to cost savings within the department.
• Operating Model: Conduct accurate intervention/reconciliation of claims, process claims within SLA, rectify errors, reconcile claims, and ensure correct payments.
• Operational Implementation of Strategy: Stay updated with operational changes, deliver in accordance with quality standards, and identify continuous improvement opportunities.
• Operational Leadership: Deliver personal performance, engage in development and mentoring, support diversity, and behave in alignment with Afrocentric values.
• Stakeholder Management: Investigate and resolve claims, respond to queries, and maintain relationships with customers and stakeholders.
• Position Specific Outputs: Duplicate check claims, capture claims, review and process claims, provide coding review, communicate with stakeholders, maintain documents, review QA reports, assist with training, and process gap claims.

Knowledge and Skills:

• Knowledge of relevant legislation, processes, scheme rules, and contractual negotiations.
• Skills include problem solving, business writing, communication, computer technology, task management, attention to detail, numerical ability, customer focus, multitasking, analytical skills, and proficiency in Microsoft Office and relevant systems.