RULES AND TARIFFS CONSULTANT

Bestmed Medical Scheme; Gauteng; On-site; ZAR 300,000 - 400,000; Full time

Benefits offered by this job

23 days annual leave

8-hour workday

Life cover

Medical aid access

On-site gym

Training opportunities

Job summary

Bestmed Medical Scheme in Gauteng has an opening for a Rules and Tariffs Consultant in the Claims Department. This role involves working closely with tariff and rules management to ensure accurate loading on the system.

Responsibilities include creating provider networks, updating pricing rules, and assisting with claims-related queries. We offer an exceptional benefits package: 23 days annual leave, training opportunities, and a supportive work environment.

Qualifications

• Minimum 1 year experience in the medical aid industry.
• Minimum 5 years Claims Experience.
• Minimum 3 years rules and tariffs experience.

Responsibilities

• Create provider networks as per agreements.
• Loading of tariff changes and conversion factor updates.
• Update/create pricing and product rules.
• Participate in Benefit design discussions.
• Assist other departments with complex system issues.

Skills

Claims Experience

Rules and Tariffs Knowledge

Business Management

Pattern Identification

Communication Skills

Education

Grade 12

Diploma/Degree in Business Management

Job description

Bestmed Gauteng has an opportunity available for a Rules and Tariffs Consultant position in the Claims Department.

Job purpose:The purpose of this position is to work hand in hand with the Tariff and rules master to ensure that the tariffs and rules are loaded correctly on the administration system and to maintain this function with regards to updates and changes.

The successful candidate should have:

• Grade 12
• Diploma/Degree in Business Management or related
• Minimum 1 year experience in the medical aid industry
• Minimum 5 years Claims Experience
• Minimum 3 years rules and tariffs experience

Key responsibilities include:

• Create provider networks as per agreements.
• Loading of tariff changes and conversion factor updates.
• Update/create pricing and product rules.
• Update scenario changes and Multi code rules where applicable.
• Identify patterns that may indicate fraud or abuse.
• Participate in Benefit design discussions.
• Assist other departments with complex system issues and claims-related queries.
• Testing and implementing changes pertaining to tickets.

Bestmed offers an exceptional benefit programme and competitive packages, including:

• 23 days annual leave
• a workday of only 8 hours, including a 30 minute lunch break.
• Permanent employees have the options under our corporate umbrella fund, which includes life cover, disability benefits, funeral cover and pension fund.
• Permanent employees also have access to medical aid.
• Access to training and development opportunities are plentiful.
• Office benefits include, free Wi-Fi, an on-site gym, and a wellness programme.

Bestmed is a non-profit, mutual, self-administered medical scheme registered with the Council for Medical Schemes. We have been providing healthcare to the lives of South Africans for over 60 years. We are the largest self-administered scheme and the fourth largest open medical scheme in South Africa.

We are committed to ensuring that all employees have opportunities for professional development, as well as fair compensation and employee benefits. We are also committed to ensuring a pleasant and mutual work environment, where innovation is welcomed and encouraged. As such, we reinforce a culture of zero tolerance towards any forms of inappropriate behaviour, abuse (including abuse of power, privilege or trust), harassment, or exploitation of any kind to safeguard our members, employees and partners. All employees are required to share in this commitment through our Code of Conduct.

Bestmed is an equal opportunity, disability-confident employer and we are committed to achieving the highest standards of diversity, fairness and equality. We conduct the most appropriate pre-employment assessments and verification checks to ensure that high standards are maintained.

Bestmed reserves the right to schedule and cancel assessments and interviews. Bestmed also reserves the right not to make a placement.

If you are willing to lead the way, go the extra mile, do the right thing, be upbeat and play for the team...you may be the perfect candidate to join a journey that is Personally Yours with Bestmed!