Technical Specialist: Claims
3 weeks ago
-Introduction
Momentum Health Solutions, an entity of Momentum MetropolitanHoldings 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 using a defined set of Health capabilities.
Role Purpose
Responsible to review the Control Reports and the correction thereof. Identify root causes for rework and how to reduce rework items. Identify training needs in Claims. Maintain business processes and the safe keeping thereof. Assist with internal and external auditors.
Requirements
- Grade 12/Matric
- 3 - 4 years claims related experience within a medical aid administration environment essential
- Data analytics experience would be an advantage
- Computer Literacy i.e. E-mail, Word and Excel essential
- Thorough knowledge of the MHS claims operating system
- Experience in electronic claims (EDI and EMB) claims assessing
Duties & Responsibilities
- Review of Daily Claims Control Reports
- Identify root causes on rework items and ways to correct the business process
- Identify training needs of employees related to claims
- Liaison with System Admin Department with regards to system problems
- Maintain and enhance business processes and the safe keeping thereof on KIP
- Assisting and manage Claims specific projects
- Liaising with internal and external auditors.
- Assessing both EDI and paper claims.
- Liaising with external business partners.
- Providing quality written feedback to claims queries.
- Assisting with claims flows between Business partners.
- E-mail investigations escalated complaints and Client service queries.
- Ensure all correspondence is archived and dealt with timeously.
- In-depth understanding of various claims processing methods.
Competencies
- Analysis
- Problem Solving
- Attention to detail
- Effective Communication Skills (verbal and written)
- Ability to work in a fast pace and pressurised environment
- Results orientated
Policy
We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.
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