Medical Claims Assessor

Healix International; Cape Town; On-site; ZAR 200 000 - 300 000; Full time

Job summary

A healthcare services provider is looking for an Operational Administrator in Cape Town. This role includes preparing medical claims, resolving administrative queries, and ensuring the accuracy of case data. Candidates should have previous experience in handling medical claims, strong customer focus, and excellent communication skills in English. This full-time position offers a monthly salary of R18,000. Closing date for applications is November 7th.

Qualifications

• Previous experience in handling medical claims.
• Ability to identify issues and escalate appropriately.
• Effective time management to prioritize tasks.

Responsibilities

• Prepare and validate operational cases accurately.
• Act as a point of contact for administrative queries.
• Ensure case data reflects accurate status and billing readiness.

Skills

Attention to detail

PC skills

Customer focus

Verbal communication in English

Written communication in English

Job description

Job Description

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We are recruiting 4 positions as a Medical Claims Assessor.

Your job title will be Operational Administrator and you will be working in our office in Claremont, Cape Town.

Location

Healix Group, Ground Floor, Brookside Office Park, 11 Imam Haron Rd

Main Purpose Of The Job Including Responsibilities

The Operational Administrator is a pivotal member of the operations team, responsible for ensuring that operational cases are accurately prepared, validated, and transitioned for financial processing.

This role supports the integrity of case data, facilitates timely invoicing and billing, and contributes to continuous process improvement.

It also includes a strong focus on resolving administrative queries, enhancing case documentation, and maintaining high standards of accuracy and compliance.

What We Are Looking For

Previous experience in handling medical claims

A high degree of accuracy and attention to detail

A positive, helpful attitude, willing to work cooperatively with other members of the team

PC skills with good knowledge of Microsoft packages

Ability to identify when it becomes appropriate to escalade a problem

Strong customer focus with excellent verbal and written communication skills in English

Strong diplomatic communicator at all levels; verbally and written to build and maintain internal and external relationships

Effective time management to be able to multi-task, prioritise to meet varying tasks and deadlines

Highly adaptable, with a flexible approach to work, willing to do what is required to ensure that the team achieves its objectives while remaining focused on quality

Ability to work well both independently and as part of a team

About The Role

Key activities / main duties :

Case Preparation & Validation

Review operational cases to ensure all required data is complete and accurate.

Confirm that services have been delivered in accordance with contractual terms.

Liaise with operational teams to resolve any discrepancies or missing information.

Improve the quality and consistency of case documentation through proactive updates and corrections.

Administrative Query Resolution

Act as a point of contact for internal and external administrative queries related to operational cases.

Investigate and resolve issues promptly to avoid delays in processing.

Maintain a log of recurring queries to identify trends and recommend preventative measures.

Invoice Readiness & Billing Coordination

Ensure all provider documentation (e.g., medical records, approvals) is received and validated.

Confirm cases meet criteria for provider invoicing and client billing.

Collaborate with the finance team to ensure accurate and timely invoicing.

Escalate issues that may impact financial processing timelines.

Back-Office Support & Data Accuracy

Monitor and update operational systems to reflect accurate case status and billing readiness.

Perform regular audits of case data to ensure compliance and accuracy.

Support the creation and maintenance of service authorisation plans and letters of guarantee

Process Improvement & Compliance

Identify opportunities to streamline case readiness and billing processes.

Ensure compliance with internal policies and external contractual obligations.

Support audits and reporting requirements as needed.

Skills Needed

Required Criteria

High degree of accuracy and attention to detail

Good PC skills

Strong customer focus with excellent verbal and written communication skills in English

Medical Claims Assessor or Claims Handling experience

Desired Criteria

Invoice and Billing experience

Closing Date

Friday 7th November,

Contract Type

Fulltime

Salary

R18, Monthly

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