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Claims Administrator
4 days ago
**Listing reference**: 018634**Listing status**: Online-
**Position summary**
**Industry**:Call Centre Industry
- **Job category**:Retail Operations**Location**:Cape Town
- **Contract**:Fixed Term Contract**Remuneration**:Market Related
- **EE position**:Yes**Introduction**
- To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections by corrective action**Job description**
**Job Objectives**:
- To resolve medical aid rejection queries with member where medical aid has no impact e.g. benefit exceeded
- To resolve medical aid rejection queries with medical scheme e.g. medication authorization
- To provide member with status update regarding rejection and resolution thereof.
- To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical aid three days prior to due date of delivery
- To resolve queries received from patients within a two hour turn-around time e.g. extended supplies due to member going oversees
**Knowledge**:
- Current IT technology (6 months)
- Medical Aid Formularies (6 months)
- Product knowledge (1 year)
- Pharmacy Council Legislation (1 year)
**Skills**:
- Communication skills
- Problem solving skills
**Competencies**:
Essential:
- Analysing
- Deciding and Initiating Action
- Adhering to Principles and Values
- Persuading and Influencing
- Working with People
- Adapting and Responding to Change
- Achieving Personal Work Goals and Objectives
- Following Instructions and Procedures
- Delivering Results and Meeting Customer Expectations
**Minimum requirements**
**Education**:
**Essential**
National Senior Certificate
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