COID Medical Claims Validator

Medical Resources Group (Pty) Ltd; Pretoria; On-site; ZAR 50 000 - 200 000; Full time

Job summary

A leading claims administrator in Pretoria East is seeking a Medical Claims Validator to join their team. The ideal candidate should possess at least 2 years of medical claims experience and a Matric/Grade 12 qualification. Key responsibilities include assessing COID claims, resolving client inquiries, and ensuring compliance with procedures. This position provides a competitive compensation package based on experience and requires excellent communication and multitasking skills.

Qualifications

• Minimum 2 years medical claims related experience is essential.
• Experience in client and funder communication is essential.

Responsibilities

• Assess COID claim information.
• Provide medical advice on claims to clients.
• Assist with client support and operational queries.
• Follow up on outstanding information required for processing.

Skills

Computer literacy in MS Office

Strong communication skills

Proactive problem-solving attitude

Multitasking ability

Education

Matric / Grade 12

Tertiary qualification

Tools

CompEasy / Medical claims online systems

Job description

Together with our client, a leading claims administrator in Pretoria East, we are recruiting for a Medical Claims Validator to join their team. The ideal candidate needs to have minimum 2 years Medical claims related experience and must have matric/grade 12.

Duties and Responsibilities

Operational

• Assess COID claim information
• Assess billing on account per item in terms of COID Gazette
• Assess accounts against payment history received from COID
• Practice management of assigned practices
• Effective communication with assigned practices
• Assisting with client support and operational queries on accounts submitted
• Provide medical advice and/or direction on claims to clients
• Following up on outstanding information required from clients and employers for processing of medical claims and invoices
• Resolve enquiries from clients related to the COID Act and medical treatment of patients
• Contribute to daily operations
• Endure that all procedures are followed and that all production goals are met
• Adhere to production deadlines
• Assist to accomplish set revenue targets
• Assist with training of newly appointed staff in the same division
• Updating DS system with the relevant claim numbers from the Compensation Fund system
• Upload of medical reports in the prescribed format on the Compensation Fund system
• Assist in other areas of the department where required

Ad-hoc

• As a team member add value and contribute to the company
• Assist to accomplish set revenue targets
• Show willingness to adapt to industry and company changes
• Show positive attitude towards your job, colleagues and clients
• Be willing to share knowledge, do training and comply with set company policies
• Assist in other areas of the department where required

Minimum Qualifications and Education Requirements

• Matric / Grade 12
• Tertiary qualification will be beneficial
• Experience in Client and Funder Communication essential
• Medical claims related experience will be essential

Preferred Skills, Competencies & Personal Traits

• Computer literate in MS Office (Microsoft Excel, Word, and Outlook)
• Articulate with strong communication skills (oral and written)
• CompEasy / Exempt funders / Medical claims online systems will be beneficial
• Exhibits an inquisitive nature and a proactive, problem-solving attitude
• Ability to adapt and learn new skills
• Ability to multitask
• Cope well under pressure

Remuneration

• Market related - depending on experience

Only candidates who meet all the requirements stipulated in this advert will be considered. If you don’t receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

To apply please send your CV and supporting documents to [e-mail] with REF: Validator