Claims Specialist X5

2 weeks ago

Cape Town, Western Cape, South Africa Health Solutions Full time

Introduction

  • Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities
    Role Purpose
  • To provide an effective and efficient service to clients by receiving, evaluating, and responding to enquiries timeously

Requirements:

  • Matric
  • Tertiary qualification (advantageous)
  • Claims School training (advantageous)
  • Computer Literacy (i.e. Email, Word, and Excel) is essential.
  • Experience in claims assessing is essential.
  • Knowledge of PMB process (advantageous)
  • 13 years of experience in the medical aid industry is essential
  • 23 years of Claims processing experience within the medical aid industry is essential.
  • 2 3 years of query management or client service experience is essential
  • Good understanding of the MH systems would be advantageous.
  • Good written and verbal communication

Duties & Responsibilities

  • Identifying risks to the company and escalating accordingly.
  • Engage in effective communication and delivery according to service levels
  • Maintaining a consistent service delivery to ensure client retention and satisfaction.
  • Respond to queries efficiently within the agreed Service Level Agreement (SLA).
  • Providing firsttime resolution on queries
  • Driving and supporting effective teamwork within the department
  • Engaging in appropriate training interventions to promote own professional development.
  • Demonstrate the company's values on a daily basis.
  • Recording of all queries and interactions with customers onto all applicable systems.
  • Escalate client queries to the relevant department or stakeholder via the applicable channel.
  • Collaborate with relevant departments to ensure the resolution of queries
  • Develop and maintain productive and collaborative work relationships with peers and stakeholders
  • Positively influence and participate in change initiatives

Competencies

  • Continuously develop own expertise in terms of professional, industry, Scheme and legislation knowledge
  • Identify opportunities to enhance costeffectiveness and increase operational efficiency
  • Business Acumen
  • Client/Stakeholder Commitment
  • Drive for Results
  • Leads Change and Innovation
  • Collaboration
  • Impact and Influence
  • Works independently
  • Diversity and Inclusiveness

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