Query Resolution Officer
4 weeks ago
**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 life time 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.
**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.
**Role Purpose**
- To ensure a professional and consistent customer service delivery through the resolution of escalated queries.
**Requirements**:
- Matric/ Grade 12
- 3 - 4 years claims assessing experience preferred
- Excellent literacy, numeracy, and communication skills
- Multi discipline claims knowledge
- Good knowledge of PMB at industry level as well as in house PMB processes
- Proven experience in the assessingof medical aid claims (paper and/orEDI) will be adventageous
- Passionate about driving a high-performance culture
- The ability to interpret and applyscheme rules correctly
- Knowledge of the NHRPL- NationalHealth Reference Price List(Previously Known as BHF) andSAMA Tariffs.
**Duties & Responsibilities**
- Accurate and timeous resolution of Claims Queries.
- Correctly reverse and reprocess the related claim
- Ensuring that no duplicate claimsare paid during the process
- Appropriate pay code is applied
- Assisting other departments with claims related queries
- Liaising with other departments to resolve queries
- Recording all queries and interactions with customers onto the workflow system
- High quality and service output
**Competencies**
- Attention to detail and accuracy
- Problem solving ability
- Ability to function effectively within a team
- Ability to work under pressure
- Consistently works to meet expectations
- Resolves client problems within his or her job scope
- Is engaged and demonstrates energy in the execution of tasks
- Accepts accountability for ownmistakes and ensures correctiveaction is taken.
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