Consultant:claims Management

2 weeks ago

Centurion, Gauteng, South Africa PPS Recruitment Full time

Job Advert Summary:

Minimum Requirements:

  • Grade 1
  • Tertiary Qualification

Experience

  • Medical Scheme Administration Experience 2 years essential
  • Assessing experience 2 years plus essential
  • Extensive understanding of the Administration System essential
  • Knowledge of Reference Price List essential
  • Indepth knowledge of Medical Scheme Rules essential
  • MS Office
  • Medical Scheme Act essential
  • Knowledge of Medical Aid Legislation and regulations essential
  • Knowledge of ICD 10 codes essential
  • Knowledge of PMB legislation essential

Duties and Responsibilities:

  • Reconcile member or provider claims received.
  • Accurate daily assessing of targets.
  • Manage quality error percentage.
  • Excellent administrative skills e.g. daily record keeping.
  • Escalate requests for corrections to relevant Consultant.
  • Follow up and resolve routed enquiries.
  • Good Communication
  • Good administration skill's, including record keeping and the ability to work under pressure
  • Must maintain a high level of productivity to asses claims daily targets set
  • High attention to detail in order to identify system risks or process shortfalls
  • Must be quality aware and quantity orientated
  • Operating System knowledge
  • Excellent time management in order to manage deadlines
  • Excellent in query resolution

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