Gap Claims Analyst: Precise & Data-Driven

Moladira Skills; Roodepoort; On-site; ZAR 180,000 - 300,000; Full time

Job summary

Moladira Skills is seeking a Claims Assessor to ensure Gap claims are accurately captured in the iMed system and processed within SLA. You will work in a healthcare and insurance environment, handling claims, data entry, and compliance with regulatory standards.

Ideal candidates have Matric with RE5, at least 3 years of relevant experience, and strong numerical, analytical and communication skills to deliver high-quality service to members and providers.

Qualifications

• Knowledge and application of relevant legislation.
• Knowledge and application of processes and procedures.
• Knowledge of scheme rules and contractual negotiations.

Responsibilities

• Follow procedures and cooperate with peers and leader for best possible service delivery.
• Defined legal, statutory and regulatory compliance is maintained at the required standards.
• Operational risk and governance structures, measures and frameworks are complied with.
• Contribute to cost savings within the department to assist with financial goals and targets.
• Accurately and efficiently process allocated claims according to the defined process and within Service Level Agreement.
• Rectify incorrect information on claims and communicate outcome.
• Maintain detailed records of claims and assessments.
• Assist with training and sharing of knowledge within the team and clients.
• Assist on the various Call centres and with call backs.
• Review and assess gap claims.
• Verify documentation and ensure all required information is completed.

Skills

Problem solving

Communication skills

Attention to accuracy and detail

Numerical ability

Multitasking

Data modelling and evaluation

Business writing skills

Adobe Creative Suite

Proficiency in Microsoft Office Suite

Education

Matric and RE5 Required

Tools

Adobe Creative Suite

Microsoft Office Suite

Job description

Moladira Skills is seeking a Claims Assessor to ensure Gap claims are accurately captured in the iMed system and processed within SLA. You will work in a healthcare and insurance environment, handling claims, data entry, and compliance with regulatory standards.

Ideal candidates have Matric with RE5, at least 3 years of relevant experience, and strong numerical, analytical and communication skills to deliver high-quality service to members and providers.