Job Description

Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group.The group enables business and people from all walks of life to achieve their financial goals andl ife aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Disclaimer

As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose

Assess and process medical aid claims as per Claims procedures.

Requirements

Matric
Computer literate.
Comprehensive knowledge of all aspects of medical aid assessing is essential.
Working on the Oracle platform is an advantage.
A minimum of 2 - 3 years' experience as a claims assessor is an advantage.
Industry knowledge (BHF; Tariff Guide; SAMA, ICD10 codes) is an advantage

Duties & Responsibilities

Accurately capture and process all incoming medical aid claims (paper, EDI, real time, workflow)with in agreed time frames.
Able to assist cross functionally in the claims department.
Processing of claims according to predetermined standards and business processes on the Oracle platform.
Ensure that claims validation is performed in accordance with legislation and scheme rules.
Quality control to ensure error rate is minimised.
Work on KRIS reports/departmental reports.
Pay claims correctly the first time and on time to members or service providers there by reducing repeat queries and escalations.

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.