Claims Specialist

4 days ago

Centurion, 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 telephonic/electronic enquiries timeously. Provide feedback to claims queries, investigations, escalated complaints, and client service queries.**Requirements**:

- Grade 12 with at least 50% achieved for Mathematics or 60% Mathematical Literacy.
- 2- 4 years claims assessing related experience within a medical aid administration environment.
- Computer Literacy (i.e. E-mail, Word and Excel).
- Thorough knowledge of the MH claims operating system.
- Experience in electronic and paper claims assessing.

**Duties & Responsibilities**
- Assessing both EDI and paper claims.
- Liaising with external business partners.
- Providing quality written feedback to claims queries.
- E-mail investigations, escalated complaints, and Client service queries.
- Ensure all correspondence is archived and dealt with timeously.
- Provider/member investigation.
- Provider/membership profiling and trend analysis.
- In-depth understanding of various claims processing methods.

**Competencies**
- Analysis
- Problem Solving
- Attention to detail
- Effective Communication Skills (verbal and written)
- Ability to work in a fast pace and pressurised environment
- Results orientated

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