Risk Management Analyst

3 days ago


Pretoria, Gauteng, South Africa Marx Enterprise Transformation Architecture Full time

Job Summary: We are seeking a detail-oriented Claims Quality Assessor to join our team, responsible for ensuring the accuracy and validity of claims processed by the Admed claims team.

The ideal candidate will possess excellent analytical and communication skills, with the ability to work effectively in a fast-paced environment.

Responsibilities:
  • Quality assessing all claims processed by the Admed claims team in the OWLS system.
  • Validating personal information, clinical information, documents attached, and decision made on the claim.
  • Conducting investigations into claims flagged by the OWLS system as possible pre-existing conditions.
  • Collaborating with internal teams to ensure seamless claims processing.
Requirements:
  • Relevant qualifications, including Matric / Grade 12 and basic medical qualification.
  • Strong MS Office computer skills.
  • Minimum 3 years claims processing and assessing experience.
  • Proven track record in insurance industry.

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