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 and life 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

Deliver accurate and timely claims administration by interpreting benefits, adjudicating claims, resolving complex queries and maintaining compliant, International Organisation Standardisation (ISO) aligned processes.

Requirements

A National Senior Certificate with Mathematics or Mathematical literacy is essential
Relevant tertiary qualification in Healthcare / Business Administration is advantageous
2-3 Years' experience in a medical scheme claims processing environment is essential
Knowledge of medical scheme rules and regulations is essential
Experience handling complex claims queries and motor vehicle accident (MVA) claims is advantageous
Experience working with tariffs and understanding of negotiated rates is advantageous
Proficiency in Microsoft Excel and PowerPoint

Duties & Responsibilities

Execute a range of administrative tasks including presentations, managing reports and analyses, resolving escalated queries, overseeing program initiatives, and collaborating to meet service delivery goals and SLAs, while ensuring accuracy and efficiency in claims and provider interactions.
Manage all motor vehicle accident (MVA) claims processes, including case documentation, attorney correspondence, record maintenance, and preparation of reports and spreadsheets.
Prepare and review medical scheme benefit documentation, ensuring accurate interpretation and sign-off of loaded benefits.
Drive exceptional stakeholder experiences by building strong relationships, understanding needs, delivering timely, high-quality service, and continuously improving processes for efficiency and client-centricity.
Foster an engaging, collaborative, and growth-oriented work culture by promoting teamwork, continuous learning, innovation, and personal development.
Support financial planning and risk management by driving cost-effectiveness and operational efficiency
Ensure compliance with ISO QMS standards by implementing, monitoring, and continuously improving processes.

Competencies

Examining information
Making decisions
Following procedures
Interpreting data
Developing expertise
Checking things
Presentation skills
* Communication skills (written and verbal)