Requirements

• Matric/ Grade 12
• 3 – 4 years claims assessing experience preferred
• Excellent literacy, numeracy, and communication skills
• Multi discipline claims knowledge
• Good knowledge of PMB at industry level as well as in house PMB processes
• Good knowledge of modifiers and their application
• Proven experience in the assessing of medical aid claims paper and/or EDI will be adventageous
• Computer literacy especially Email, Word and Excel
• Passionate about driving a high-performance culture
• The ability to interpret and apply scheme rules correctly
• Knowledge of the NHRPL- National Health Reference Price List Previously Known as BHF and SAMA Tariffs

Duties & Responsibilities

• Accurate and timeous resolution of Claims Queries.
• Correctly reverse and reprocess the related claim
• Ensuring that no duplicate claims are paid during the process
• Appropriate pay code is applied
• Assisting other departments with claims related queries
• Liaising with other departments to resolve queries
• Recording all queries and interactions with customers onto the workflow system
• High quality and service output

Competencies

• Attention to detail and accuracy
• Problem solving ability
• Ability to function effectively within a team
• Ability to work under pressure
• Consistently works to meet expectations
• Resolves client problems within his or her job scope
• Is engaged and demonstrates energy in the execution of tasks
• Accepts accountability for own mistakes and ensures corrective action is taken