Claims Assessor MMH250402-2

3 weeks ago


Durban, KwaZulu-Natal, South Africa Momentum Full time

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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