Temporary Medical Claims Assessor MMH251121-20

Momentum; Gqeberha; On-site; ZAR 180 000 - 240 000; Full time

Job summary

A financial services provider is seeking a Claims Team member in Gqeberha. You will ensure the accurate insertion and assessment of claims, while meeting performance indicators and service level agreements. Candidates should hold a National Senior Certificate and have at least 1 year of administrative experience, ideally in a medical scheme setting. Proficiency in MS 365 is essential for this role.

Qualifications

• Minimum of 1 year experience in an administrative role.
• Prior experience in a medical scheme claims assessing environment is preferred.

Responsibilities

• Ensure precise insertion and assessing of claims following SLAs.
• Provide professional assistance to clients regarding claims inquiries.
• Conduct regular reporting and analysis of claims data.

Skills

Administrative skills

Proficiency in MS 365

Education

National Senior Certificate

Job description

Role Purpose

To effectively contribute to the Claims Team, ensuring that the Team’s key performance indicators and the Schemes’ service level agreements are met by accurately inserting and assessing claims according to protocol.

Requirements

• It is essential to have a National Senior Certificate (Bachelor's pass with Mathematics or Mathematical Literacy as a Grade 12 subject highly advantageous)
• A minimum of 1 years’ experience in an administrative role is essential (medical scheme environment is highly advantageous)
• Prior experience in a medical scheme claims assessing environment is preferred
• Proficiency in MS 365 is essential

Duties and Responsibilities

• Ensure precise insertion and assessing of claims, adhering to the defined service level agreements (SLAs) and ensuring all steps are completed accurately within the designated timeframes.
• Action all claims-related adjustments based on journal instructions received from various departments.
• Provide professional, responsive assistance to clients and other key stakeholders by addressing and resolving claims-related inquiries, ensuring that all interactions are conducted in line with the specified service level agreements and meet established quality standards.
• Identify and elevate any claims-related queries that require additional investigation or further attention to the appropriate team leader, ensuring a timely and efficient resolution.
• Conduct regular and detailed reporting and analysis of claims data.
• Perform necessary corrections to following investigation, ensuring adjustments are made accurately and in accordance with established protocols and guidelines.