Claims Expertise Specialist

7 days ago


Sandton, South Africa HR Studio Ltd Full time

We are seeking a Claims Expertise Specialist to join HR Studio Ltd. The successful candidate will be responsible for timely and accurate processing and adjudication of claims.

The role involves researching and processing claims or related requests for covered members or providers across various products including medical, pharmacy, vision and related healthcare options.

Key responsibilities include reviewing assigned claims or requests from a queue, maintaining a set inventory level, analyzing claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract, and/or policy.

The ideal candidate will have strong analytical skills, attention to detail, and the ability to make informed decisions using available resources and sound judgment.

A bachelor's degree in a relevant field is preferred, but not required. The company offers a competitive salary range of $60,000 - $80,000 per annum, depending on experience.

Benefits

  • A comprehensive benefits package, including health insurance, retirement plan, and paid time off
  • Ongoing training and development opportunities
  • A collaborative and dynamic work environment

Requirements

  • Matric Diploma or equivalent, bachelor's degree preferred or experience in lieu of degree
  • 2 years of medical claims processing experience, including knowledge of medical terminology and working in a production environment
  • Ability to adapt to changes in the work environment, manage competing demands, and handle frequent changes, delays, or unexpected events effectively
  • Strong communication and interpersonal skills, with the ability to build trust with management, colleagues, and customers

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