Medical Claims Review Officer

Key Performance Areas Audit & review medical bills. - Analysis of claimed items/services in correlation with available tariff structures and ICD 10 /CPT 4 codes. - Requesting motivation for unreasonable accounts. - Line by line analysis of claim items/service. Matching those appropriate tariffs/ICD/CPT codes. - Flagging rejected items/services. -...

Key Performance AreasAudit & review medical bills.Analysis of claimed items/services in correlation with available tariff structures and ICD 10 /CPT 4 codes.Requesting motivation for unreasonable accounts.Line by line analysis of claim items/service. Matching those appropriate tariffs/ICD/CPT codes.Flagging rejected items/services.Recommendations to...

About the RoleWe are seeking a highly skilled Medical Claims Review Officer to join our team at Nambiti Technologies. This exciting opportunity allows you to play a vital role in ensuring the efficient and effective processing of medical claims.Job DescriptionThe Medical Claims Review Officer will be responsible for reviewing medical bills, analyzing claimed...

A well-established financial services business is seeking to appoint a Officer: Bill Review - 6 Months Fixed Term Contract **Purpose of the Job**: - Audit & review Medical Bills. - Analysis of claimed items/services in correlation with available tariff structures - Auditing medical claims and assisting in technical aspects of bill review. - Assess and...

Purpose of the Job: - Audit & review Medical Bills. - Analysis of claimed items/services in correlation with available tariff structures - Auditing medical claims and assisting in technical aspects of bill review. - Assess and monitor claims to curb over servicing or abuse and fraudulent claims. Qualifications and Experience: - Bachelors Degree or...

Purpose of the Job: Audit & review Medical Bills.Analysis of claimed items/services in correlation with available tariff structuresAuditing medical claims and assisting in technical aspects of bill review.Assess and monitor claims to curb over servicing or abuse and fraudulent claims.Qualifications and Experience:Bachelors Degree or Advanced Diploma in...

Purpose of the Job : Audit & review Medical Bills. Analysis of claimed items/services in correlation with available tariff structures Auditing medical claims and assisting in technical aspects of bill review. Assess and monitor claims to curb over servicing or abuse and fraudulent claims. Qualifications and Experience: Bachelors Degree or Advanced Diploma...

Job Description:We are seeking a skilled Medical Bill Auditor to join our team at Six Sense Consulting. As a key member of our team, you will play a crucial role in analyzing medical claims and ensuring compliance with relevant tariff structures.About the Role:This is an exciting opportunity for a highly motivated individual with a strong background in...

Role PurposeAssess, review, and manage living benefit claims in accordance with relevant legislation and company policy, meeting client and business expectations.Key ResponsibilitiesClaims Assessment: Assess, review, and manage disability, dread disease, and income disability claims, as well as other claims requiring a medical assessment component, in line...

About MetropolitanMetropolitan is a renowned financial services brand in South Africa, boasting a 116-year legacy of serving local communities through affordable and innovative solutions. As part of MMI Holdings Ltd, we empower individuals and families to achieve financial growth and security.Our presence extends across South Africa and seven African...

**Introduction**Role Purpose** - To provide specialist and accurate death benefit claim decisions, through assessing client’s information as well as medical information aligned to the product and policy agreement.**Requirements**: - Matric - Relevant business-related qualification. - Relevant Insurance/Financial services Industry, applicable regulatory...

Closing Date2023/03/20Reference NumberMMH230301-6Job TitleClaims AssessorPosition TypePermanentRole FamilyClient ServicesClusterHealth SolutionsRemote OpportunitySome of the timeLocation - CountrySouth AfricaLocation - ProvinceGautengLocation - Town / CityCenturionIntroduction Metropolitan is one of the oldest financial services brands in South Africa. With...

**Introduction** Momentum Health Solutions, anentity of MomentumMetropolitan Holdings deliverssustainable, integrated healthsolutions that meet the needs ofclients in the different segmentsand maximise lifetime clientvalue. We build and maintain aculture of innovation, and createvalue through unique insights ofhow to achieve specificoutcomes by using a...

**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...

**Purpose**: The Manager: Actuarial Claims Risk is responsible to manage the provision of Actuarial Claims Risk support and advice to the business **Qualifications and Experience** - Bachelor’s Degree/Advanced Diploma in Actuarial Science/Mathematics related qualification. - Qualified Associate/Fellow Actuary of (ASSA/IFoA/SoA/CAS) or any other...

**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...

**Introduction**Role Purpose**Requirements**: - Relevant Insurance/Financial services Industry knowledge and experience, applicable regulatory requirements, and legislations. - Extensive knowledge of Section 37C of the Pension Funds Act. (essential). - 5 years proven track record in a leadership role/people management (essential). - MS Office Suite (Word,...

Job Title: Claims AssessorMetropolitan is a leading financial services brand in South Africa, with a legacy of serving communities for over 116 years. We provide affordable financial solutions that create financial growth and security for our clients.Job SummaryWe are seeking a skilled Claims Assessor to join our team. The successful candidate will be...

**Introduction**Role Purpose** - To be part of a team that provides market leading claims assessment capability for living benefits (critical illness, income and disability benefits). This will include specialising in income disability, lump sum disability,critical illness and case management for living benefits, the completion of quality industry...

Job OverviewThe Claims Resolution Specialist will be responsible for the effective handling and settlement of claims. This includes accurately reserving claims, reviewing insurance policies to determine coverage, and providing excellent customer service.Key ResponsibilitiesReserve claims accurately and efficientlyReview insurance policies to determine...