Job Description

Closing Date 2025/10/14
Reference Number MMH251003-8
Job Title Claims Assessor
Position Type Temporary
Role Family Client Services
Cluster Momentum Health
Remote Opportunity None of the time
Location - Country South Africa
Location - Province KwaZulu-Natal
Location - Town / City Durban
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.

Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

Skills Required