Consultant:claims Management

**Job Advert Summary**:
**Minimum Requirements**:

- Grade 12
- Tertiary Qualification

**Experience**
- Medical Scheme Administration Experience 2 years essential
- Assessing experience 2 years plus essential
- Extensive understanding of the Administration System essential
- Knowledge of Reference Price List essential
- In-depth knowledge of Medical Scheme Rules essential
- MS Office
- Medical Scheme Act essential
- Knowledge of Medical Aid Legislation and regulations essential
- Knowledge of ICD 10 codes essential
- Knowledge of PMB legislation essential

**Duties and Responsibilities**:

- Reconcile member or provider claims received.
- Accurate daily assessing of targets.
- Manage quality error percentage.
- Excellent administrative skills e.g. daily record keeping.
- Escalate requests for corrections to relevant Consultant.
- Follow up and resolve routed enquiries.
- Good Communication
- Good administration skill’s, including record keeping and the ability to work under pressure
- Must maintain a high level of productivity to asses claims daily targets set
- High attention to detail in order to identify system risks or process shortfalls
- Must be quality aware and quantity orientated
- Operating System knowledge
- Excellent time management in order to manage deadlines
- Excellent in query resolution