Medical Aid Claims Assessor

3 weeks ago


Pretoria, South Africa Medpharm Recruitment Full time

A reputable Medical Aid is seeking an experienced Medical Aid Claims Assessor to join their HBM team in Pretoria. (Office based)

**Requirements**:

- Grade 12
- Staff/Enrolled or Registered Nurse (SANC)
- Minimum 5 years’ experience as a Nursing Practitioner
- Minimum 1 year experience gained in the medical funding industry
- 1 year Medical Aid claims auditing experience **(Essential)**

**Duties**:

- Delivering cost effective managed healthcare service to accomplish member satisfaction.
- Ensuring that hospital accounts are audited in accordance with the Scheme's rules, guidelines and the different Hospital contracts.
- To ensure that hospital accounts are assessed in accordance with the Scheme's rules, guidelines and the different hospital contract, within the turnaround time.
- Paper claims assessment.
- Measuring individual error rate to ensure no costs incurred due to assessing errors made.

**Job Types**: Full-time, Permanent

**Salary**: R1.00 - R2.00 per month

Application Question(s):

- Where have you previously worked as a Clinical/Medical Claims assessor?
- What is your minimum salary expectation? (Before deductions)

**Education**:

- Certificate (required)

**Experience**:

- Nursing: 5 years (required)

License/Certification:

- SANC (required)

Ability to Relocate:

- Pretoria, Gauteng: Relocate before starting work (required)


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