Tariffs & Rules Strategist – Medical Claims

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 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.