Medical Claims Administrator

Pillangó Placements; Durban; On-site; ZAR 167,000 - 223,000; Full time

Job summary

Pillangó Placements seeks a Medical Claims Administrator to deliver accurate administrative medical debt services to clients and provide doctors with real-time monitoring reports. You will build partnerships to improve cash flow and minimize aged debt.

The role demands accurate data capture, claims submission quality, and proactive follow-ups with practices and clients in a fast-paced healthcare tech environment.

Qualifications

• Must have knowledge on PMBs.
• High level of computer literacy required.
• High level of numeracy required.
• Google Workspace experience advantageous.

Responsibilities

• Capture patient demographics and claims accurately.
• Ensure all claims are accurate before submission to Medical Schemes.
• Clear claim rejections as soon as notified.
• Reconcile and monitor remittances.
• Follow-up on all outstanding claims.
• Maintain a low age analysis.
• Follow up on short payments.
• Follow up on claims regularly with updates at each query.

Skills

PMBs knowledge

Numeracy

Computer literacy

Communication skills

Education

Matric

Administrative qualification advantageous

Tools

Google Workspace

Job description

Are you eager to grow and join a highly specialised team in the area of medical claims and debt management? Become part of an exciting service based solution driven on the back of cutting edge healthcare technology.

As a Medical Claims Administrator, you will be required to deliver an efficient , consistent and accurate administrative medical debt service to clients. You will also provide the Doctors with monitoring and bureau reports that will allow them to have real time data on the financial status of their practice. You will become a trusted business partner ensuring that their cash flow is timeous and that aged debt is at a minimum.

Key Responsibilities:

• Capture patient demographics and claims accurately.
• Ensure that all claims are accurate before they are submitted to the Medical Schemes
• Clear claim rejections as soon as notified.
• Reconcile and monitor all remittances.
• Follow-up on all outstanding claims.
• Correct/resubmit claim rejections.
• Maintain a low age analysis.
• Follow up on short payments.
• Follow up on claims regularly with valid updates at each point of query.
• Keep constant communication open with the practice and the client.
• Build and maintain relationships with clients.
• Monitor and maintain doctors' databases.

Qualifications and Experience

• Matric
• A relevant administrative qualification is advantageous
• 2 to 3 years industry experience is essential

Knowledge and Skills

• Must have knowledge on PMBs
• High level of computer literacy
• High level of numeracy
• Google Workspace experience is advantageous

The proposed salary for the role is R15k - R20k per month - the final offer will depend on qualifications, experience and skills.