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Claims Assessor MMH250122-7 Expert

1 week ago


Port Elizabeth, Eastern Cape, South Africa Momentum Full time
Job Description

Momentum is seeking an experienced Claims Assessor to join our dynamic Claims Team. As a key member of the team, you will play a crucial role in ensuring that our service level agreements are met and our clients receive exceptional service.

Main Responsibilities:

  • Accurately insert and assess claims according to protocol.
  • Action all claims-related adjustments based on journal instructions received from various departments.
  • Provide professional assistance to clients and stakeholders by addressing and resolving claims-related inquiries.
  • Identify and escalate any claims-related queries requiring additional investigation or attention.
  • Conduct regular reporting and analysis of claims data.
  • Perform necessary corrections to claims following investigation.

Requirements:

  • National Senior Certificate (Bachelor's pass with Mathematics or Mathematical Literacy as a Grade 12 subject highly advantageous)
  • A business-related degree or diploma is preferred.
  • Minimum 1 year's experience in an administrative role required.
  • Prior experience in a medical scheme administrative environment is preferred.
  • Familiarity with medical claims processing and ICD-10 coding is highly advantageous.
  • Proficiency in the Microsoft Office Suite is essential.