Claims Assessor MMH250402-2
3 weeks ago
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 and Responsibilities
- Accurately capture and process all incoming medical aid claims (paper, EDI, real time, workflow) within 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 minimized.
- Work on KRIS reports / departmental reports.
- Pay claims correctly the first time and on time to members or service providers thereby reducing repeat queries and escalations.
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