Medical Claims Assessor

Job Description Get AI-powered advice on this job and more exclusive features. We are recruiting 4 positions as a Medical Claims Assessor. Your job title will be Operational Administrator and you will be working in our office in Claremont, Cape Town. Location Healix Group, Ground Floor, Brookside Office Park, 11 Imam Haron Rd Main Purpose Of The Job Including Responsibilities The Operational Administrator is a pivotal member of the operations team, responsible for ensuring that operational cases are accurately prepared, validated, and transitioned for financial processing. This role supports the integrity of case data, facilitates timely invoicing and billing, and contributes to continuous process improvement. It also includes a strong focus on resolving administrative queries, enhancing case documentation, and maintaining high standards of accuracy and compliance. What We Are Looking For Previous experience in handling medical claims A high degree of accuracy and attention to detail A positive, helpful attitude, willing to work cooperatively with other members of the team PC skills with good knowledge of Microsoft packages Ability to identify when it becomes appropriate to escalade a problem Strong customer focus with excellent verbal and written communication skills in English Strong diplomatic communicator at all levels; verbally and written to build and maintain internal and external relationships Effective time management to be able to multi-task, prioritise to meet varying tasks and deadlines Highly adaptable, with a flexible approach to work, willing to do what is required to ensure that the team achieves its objectives while remaining focused on quality Ability to work well both independently and as part of a team About The Role Key activities / main duties : Case Preparation & Validation Review operational cases to ensure all required data is complete and accurate. Confirm that services have been delivered in accordance with contractual terms. Liaise with operational teams to resolve any discrepancies or missing information. Improve the quality and consistency of case documentation through proactive updates and corrections. Administrative Query Resolution Act as a point of contact for internal and external administrative queries related to operational cases. Investigate and resolve issues promptly to avoid delays in processing. Maintain a log of recurring queries to identify trends and recommend preventative measures. Invoice Readiness & Billing Coordination Ensure all provider documentation (e.g., medical records, approvals) is received and validated. Confirm cases meet criteria for provider invoicing and client billing. Collaborate with the finance team to ensure accurate and timely invoicing. Escalate issues that may impact financial processing timelines. Back-Office Support & Data Accuracy Monitor and update operational systems to reflect accurate case status and billing readiness. Perform regular audits of case data to ensure compliance and accuracy. Support the creation and maintenance of service authorisation plans and letters of guarantee Process Improvement & Compliance Identify opportunities to streamline case readiness and billing processes. Ensure compliance with internal policies and external contractual obligations. Support audits and reporting requirements as needed. Skills Needed Required Criteria High degree of accuracy and attention to detail Good PC skills Strong customer focus with excellent verbal and written communication skills in English Medical Claims Assessor or Claims Handling experience Desired Criteria Invoice and Billing experience Closing Date Friday 7th November, Contract Type Fulltime Salary R18, Monthly #J- Ljbffr #J-18808-Ljbffr