Claims Assessor

3 weeks ago


Eastern Cape, South Africa Health Solutions Full time

**Introduction**
- Momentum Health, an entity of the Momentum Metropolitan Group, 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.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.

**Role Purpose**
- To effectively contribute to the Claims Team, ensuring that the Team’s key performance indicators and the Schemes’ service level agreements are met by accurately inserting and assessing claims according to protocol.

**Requirements**:

- A minimum of 1 years’ experience in a medical scheme administrative environment is required
- Familiarity with claims processing and ICD-10 coding is highly advantageous
- Proficiency in the Microsoft Office Suite is essential

**Duties & Responsibilities**
- Ensure precise insertion and assessing of claims, adhering to the defined service level agreements (SLAs) and ensuring all steps are completed accurately within the designated timeframes.
- Provide professional, responsive assistance to clients and other key stakeholders by addressing and resolving claims-related inquiries, ensuring that all interactions are conducted in line with the specified service level agreements and meet established quality standards.
- Identify and escalate any claims-related queries that require additional investigation or further attention to the appropriate team leader, ensuring a timely and efficient resolution.
- Conduct regular and detailed reporting and analysis of claims data.
- Perform necessary corrections to claims following investigation, ensuring adjustments are made accurately and in accordance with established protocols and guidelines.

**Competencies**
- Accountability
- Time management
- Attention to detail
- Teamwork and cooperation
- Business administration skills
- Examining information
- Interpreting data
- Analysing information


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