Rules & Tariff Master (Claims Dept) - Medical Aid

The purpose of this position is to ensure that all claims are assessed using the appropriate rules and is paid correctly in line with the Scheme's benefit and tariff structures. **Duties**: - Assessing and processing Medical Aid claims - **Quality**:Measuring of individual error rate to ensure no costs incurred due to assessing errors made. -...

Our client, a non-profit, medical scheme is seeking – Claims Assessor for the Pretoria area. Duties include but not limited to: • Ensure that all claims are assessed using the appropriate rules and is paid correctly in line with the Medical Schemes benefit and tariff structures. Requirements: • Grade 12 • A minimum of 2 years claims assessing...

A reputable Medical Aid is seeking an experienced DUR Pharmacist to join their team in Pretoria. **Duties**: - Medicine authorisations as per Scheme rules and protocols to ensure cost-effective reimbursement of medicine and medicine cost containment. - Ensure medicine benefit allocations are applied and executed correctly according to Scheme...

**Short-term and Medical Aid Administrator, R17500 - R20k** **Silverlakes area - EXCELLENT CAREER OPPORTUNITY** **Upmarket company in the Financial Services Industry providing Turnkey financial services requires the following**: **About the Position** A recognized accredited and independent exclusive has an opportunity for an experienced Short-term...

**Medical Billing Claims Administrator** Company based in Mooikloof (Pretoria East) is excited to offer an employment opportunity to an experienced Medical Billing Administrator. Minimum requirements to apply: - Driver's license (ESSENTIAL). - Matric/Grade 12 qualification (ESSENTIAL). - 2 years' relevant experience (ESSENTIAL). - Computer skills -...

**Medical Billing Claims Administrator** Company based in Mooikloof (Pretoria East) is excited to offer an employment opportunity to an experienced Medical Billing Administrator. Minimum requirements to apply: - Driver's license (ESSENTIAL). - Matric/Grade 12 qualification (ESSENTIAL). - 2 years' relevant experience (ESSENTIAL). - Computer skills -...

A reputable Medical Aid based in KZN is seeking a Regional Service Consultant to join their team. **Duties**: - Service delivery to all stakeholders in specific regions. (These include Members, Advisors, Providers and Suppliers in accordance to prescribed processes) - Coordinating the functions and logistics of the regional office and responsible for all...

Bring your possibility to life! Define your career with us - With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.Job Summary To...

Duties include but will not be limited to: - Reaching target - Selling and marketing products to the public - Cold calling clients to obtain business and leads - Gathering information and documentation needed to request quotations and fulfil compliance standards - Perform financial needs analysis to assess the needs of the client, before a product is...

A reputable Medical Aid is seeking a Business Consultant to join their team in Pretoria. **Duties**: - Responsibility and accountability for executing advisor training, support and relationship building in order for the Scheme to be positioned as the "**Scheme of choice"** for the Intermediary and their Clients. - To implement effective strategies that...

2years **Job Duties/Responsibilities will include**: Dealing with customer queries telephonically. Calculating various claims and paying out of claims. Utilising the functions of the Natural and Alex systems to carry out the day-to-day activities. Administration of Retirement claims for MIPF/EIPF. Corresponding with external customers Grade 12 with an...

**Duties**: - Responsible for benefit-risk management through the following actions: - Evaluate and authorise procedures and out-of-hospital benefits; - Assist Case Management with the clinical justification of hospital benefits, including appropriate levels of care and/or alternatives to hospital admission; - Give input regarding the management of...

**Job description medical malpractice representative** **Summary** Investigates and evaluates complex and severe claims, primarily related to medical malpractice. Participates in all aspects of a claim file, under the direction of a claim’s attorney, including data gathering, investigation, and development of claim summaries and timelines. Prepares and...

Assistant Director: Medical Payments Ref No: Hr 5/1/2/3/28 (X2 Posts) SALARY: R424 104 per annum CENTER: Compensation Fund, Pretoria REQUIREMENTS: Three-year tertiary qualification in Accounting/Finance/Internal Audit/Informatics/Business Management/Operations Management/Public Administration/Clinical Qualification. 4 years' functional experience in...

About the job Medical Receptionist Our client, a Radiation Oncologist based in Pretoria is urgently seeking to recruit a medical receptionist. **Requirements**: - Diary and appointment management - Practice management - Answering incoming calls - Assisting with the check-out process or rescheduling of appointments - Ensure the smooth and effective...

**ABOUT** Intercare is a dynamic healthcare company focusing on offering value-based healthcare to patients. As ambassadors of the Intercare brand, everything we do is guided by our purpose to make people feel better. Our shared values of People-centred, Integrity, Inclusivity, Compassion, Excellence and Innovation define what we believe and who we...

We wish to employ a Hearing Aid Technician at our one of our businesses in the Pretoria area that will be trained in the finer aspects of servicing, repairing as well as the operation of electronic medical appliances. The successful person will be a salesperson at heart, fully bilingual (Afrikaans and English), have the ability to do detailed and fine work,...

Work experienceAt least 2 - 3 year's experience in processing claims . 1 Year experience in forensic/investigative claims assessing or dealing with fraud, waste and abuse claims in a medical scheme .Requirements:Knowledge related to the industry will be a requirement. Experience in claims assessing and the understanding thereof. An understanding of...

Work experienceAt least 2 - 3 year's experience in processing claims . 1 Year experience in forensic/investigative claims assessing or dealing with fraud, waste and abuse claims in a medical scheme .Requirements:Knowledge related to the industry will be a requirement. Experience in claims assessing and the understanding thereof. An understanding of claims...

Work experience At least 2 - 3 year's experience in processing claims . 1 Year experience in forensic/investigative claims assessing or dealing with fraud, waste and abuse claims in a medical scheme . Requirements: Knowledge related to the industry will be a requirement. Experience in claims assessing and the understanding thereof. An understanding of...