Tariffs & Rules Specialist – Claims & Pricing

Bestmed Medical Scheme; Pretoria; On-site; ZAR 360,000 - 480,000; Full time

Benefits offered by this job

23 days annual leave

8-hour workday

Life cover

Disability benefits

Funeral cover

Pension fund

Medical aid

Training opportunities

Free Wi‑Fi

On-site gym

Wellness programme

Job summary

Bestmed invites applications for a Rules and Tariffs Consultant in the Claims Department. The role focuses on ensuring tariffs and rules are accurately loaded on the administration system and maintained during updates and changes.

The ideal candidate has a Diploma/Degree in Business Management or related, with at least 5 years in claims and 3 years in rules and tariffs, plus 1 year in the medical aid industry.

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 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.

Education

Diploma/Degree in Business Management or related

Grade 12

Job description

Bestmed invites applications for a Rules and Tariffs Consultant in the Claims Department. The role focuses on ensuring tariffs and rules are accurately loaded on the administration system and maintained during updates and changes.

The ideal candidate has a Diploma/Degree in Business Management or related, with at least 5 years in claims and 3 years in rules and tariffs, plus 1 year in the medical aid industry.