Medical Aid Claims Specialist
2 weeks ago
Job Title: Medical Aid Claims Specialist
Job Summary: We are seeking a highly skilled Medical Aid Claims Specialist to join our team at Palesa Mbali Group. The ideal candidate will have a strong background in medical aid claims processing and excellent communication skills.
Key Responsibilities:
- Ensure defined legal, statutory, and regulatory compliance is maintained at the required standards
- Operational risk and governance structures, measures, and frameworks are complied with and necessary action is taken to address issues when necessary
- Ensure that payments are processed at the correct rate and against available benefits
- Investigate all documentation, correct where required, and link to member records
- Analyse and correct incorrect payments and identify the reason for non-payment
- Apply the Quality Analysis checklist to the processing of claims
- Provide comprehensive and accurate feedback to clients
- Identify system constraints and escalate accordingly
- Assist in Call Centre/other areas when required
- Ensure that quality control targets are met
- Meet delivery objectives through working with other team members within and linked to the department/project
- Resolve operational performance variations and problems and escalate unresolved issues to higher levels
- Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery
- Ensure appropriate, active, and informative relationships with customers and relevant stakeholders are successfully achieved
- Address customer or stakeholder complaints in alignment with policies and procedures and ensuring customer/stakeholder buy-in
Requirements:
- Problem-solving and decision-making skills
- Business writing skills
- Communication skills
- Computer technology skills
- Task management
- Adobe Creative Suite
- Data modelling and evaluation
- Attention to accuracy and detail
- Numerical ability
- Customer focus
- Relevant systems knowledge and application
Experience and Qualifications:
1-2 years' experience in the medical aid industry is essential, business writing skills in English are required, investigative, communication, and interpersonal skills are required, and in-depth working knowledge of client rules will be advantageous
-
Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeJob Title: Agent: Contact CentreThe Palesa Mbali Group is seeking a skilled and experienced Agent to join our Contact Centre team. As an Agent, you will be responsible for engaging with service-related calls and queries from medical scheme members and providers, providing relevant business information and solutions.Key Responsibilities:Handle telephone and...
-
Medical Billing Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa Ultra Personnel Full timeJob SummaryWe are seeking a skilled Medical Billing Specialist to join our team at Ultra Personnel.The ideal candidate will have a strong background in medical billing and a keen eye for detail. They will be responsible for ensuring accurate and timely processing of medical claims, as well as maintaining compliance with industry regulations.Key...
-
Medical Biller ICD 10 Specialist
2 months ago
Johannesburg, Gauteng, South Africa Sheli Placements Full timeMedical Billing Specialist Job DescriptionWe are seeking a highly skilled Medical Billing Specialist to join our team at Sheli Placements. As a Medical Billing Specialist, you will be responsible for processing and managing medical claims, ensuring accurate and timely payment from insurance companies.Key Responsibilities:Process and manage medical claims,...
-
Claims Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa Rad Resources Full timeJob Title: Claims SpecialistAt Rad Resources, we're seeking a skilled Claims Specialist to join our team. As a key member of our claims administration team, you'll be responsible for managing claims portfolios and ensuring timely and efficient resolution of claims.Key Responsibilities:Administer claims portfolios, including motor and non-motor claimsManage...
-
Medical Aid Contact Centre Professional
2 weeks ago
Johannesburg, Gauteng, South Africa Palesa Mbali Group Full timeThe Palesa Mbali Group is seeking a highly skilled Medical Aid Contact Centre Professional to engage service-related calls and queries from medical scheme members and providers.Main Responsibilities:Handle service-related calls and queries from medical scheme members and providers, providing relevant business information and solutions.Maintain and manage...
-
Claims Specialist
1 month ago
Johannesburg, Gauteng, South Africa Energy at Work Projects Full timeJob Title: Claims HandlerJob Summary:We are seeking a highly skilled Claims Handler to join our team at Energy at Work Projects. As a Claims Handler, you will be responsible for handling claims efficiently, ensuring that customers receive excellent service, and maintaining accurate records.Key Responsibilities:Capture and process new claims in a timely and...
-
Claims Specialist
1 month ago
Johannesburg, Gauteng, South Africa CFS Recruitment Full timeJob Title: Non-Motor ClaimsWe are seeking a highly skilled and experienced Claims Specialist to join our team at CFS Recruitment. The ideal candidate will have a strong background in non-motor claims and excellent customer service skills.Key Responsibilities:Manage and resolve non-motor claims in a timely and efficient mannerConduct thorough investigations...
-
Insurance Claims Specialist
1 month ago
Johannesburg, Gauteng, South Africa CFS Recruitment (Pty) Ltd Full timeJob Title: Binder & Outsourced Claims SpecialistCFS Recruitment (Pty) Ltd is seeking a skilled Binder & Outsourced Claims Specialist to join our team. As a key member of our insurance team, you will be responsible for validating and processing short-term insurance claims following a fortuitous event.Key Responsibilities:Validate and process short-term...
-
Insurance Claims Specialist
4 weeks ago
Johannesburg, Gauteng, South Africa CFS Recruitment (Pty) Ltd Full timeJob Title: Binder & Outsourced Claims SpecialistCFS Recruitment (Pty) Ltd is seeking a highly skilled Binder & Outsourced Claims Specialist to join our team. The successful candidate will be responsible for validating and processing short-term insurance claims following a fortuitous event.Key Responsibilities:Validate and process short-term insurance claims...
-
Commercial Claims Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa CFS Recruitment Full timeJob Title: Commercial Claims SpecialistCFS Recruitment is seeking a skilled Commercial Claims Specialist to handle all aspects of commercial claims in the insurance sector.Key Responsibilities:Assessing claims to determine validity and liabilityInvestigating claims to gather necessary informationNegotiating settlements with clients and third...
-
Claims Specialist
2 months ago
Johannesburg, Gauteng, South Africa CFS Recruitment Full timeCFS Recruitment is seeking a skilled Claims Specialist to join our team. The ideal candidate will possess a strong understanding of insurance principles and a proven track record in non-motor claims. Key responsibilities include: **Minimum Requirements:** * Matric qualification * RE 5 certification * FETC in Short-Term Insurance * TIAL certification *...
-
Insurance Claims Specialist
2 months ago
Johannesburg, Gauteng, South Africa Planet10 Full timePlanet10 is seeking a Claims Assessors to form part of their Team. This role will provide specialist advice and support in the generation and provision of reliable claims assessment activities, to support key deliverables and informed decision making, through the execution of predefined objectives as per agreed SOPs. The ideal candidate will have 5 years...
-
Medical Biller ICD 10 Specialist
4 weeks ago
Johannesburg, Gauteng, South Africa Sheli Placements Full timeJob Title: Medical Biller ICD 10 SpecialistWe are seeking a skilled Medical Biller with experience in ICD 10 codes to join our team at Sheli Placements.Job Description:A Medical Billing Company is looking to hire billers with a minimum of 3 years experience. The ideal candidate will be fully computer literate and bilingual, with a strong knowledge of ICD 10...
-
Senior Claims Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa Six Sense Consulting Full timeClaims Specialist Job DescriptionSix Sense Consulting is seeking a highly skilled Claims Specialist to join our team. The ideal candidate will have a strong background in commercial claims and excellent negotiation skills.Key Responsibilities:Manage and resolve commercial claims in a timely and efficient manner.Negotiate with clients and stakeholders to...
-
Claims Handler Specialist
2 weeks ago
Johannesburg, Gauteng, South Africa Energy at Work Projects Full timeJob Title: Claims Handler SpecialistDescription:We are seeking a talented Claims Handler Specialist to join our team at Energy at Work Projects. In this role, you will be responsible for handling and resolving claims in a timely and efficient manner.Key Responsibilities:Capture and process new claims in accordance with company policies and procedures.Serve...
-
Commercial Claims Specialist
4 weeks ago
Johannesburg, Gauteng, South Africa Mirror Images Full timeJob Title: Commercial Claims SpecialistWe are seeking a highly skilled Commercial Claims Specialist to join our team. As a key member of our claims handling team, you will be responsible for managing and resolving commercial claims in a timely and efficient manner.Key Responsibilities:Register all new claims received and raise an appropriate reserve as...
-
Clinical Care Specialist
1 week ago
Johannesburg, Gauteng, South Africa St. John's Riverside Hospital Full timeOverviewSt. John's Riverside Hospital is a leading healthcare provider in Westchester, dedicated to delivering high-quality, compassionate care to the community.The Hope Center at St. John's Riverside Hospital seeks an experienced Clinical Care Specialist to provide primary care services to clients/patients living with HIV/AIDS, Hepatitis C, and...
-
Commercial Claims Specialist
3 weeks ago
Johannesburg, Gauteng, South Africa Mirror Images LTD Full timeJob Title: Commercial Claims SpecialistJob Summary: We are seeking a highly skilled Commercial Claims Specialist to join our team at Mirror Images LTD. The successful candidate will be responsible for handling commercial claims, motor, and non-motor insurance claims, and ensuring timely and efficient resolution of claims.Key Responsibilities:Register all new...
-
Claims Resolution Specialist
3 weeks ago
Johannesburg, Gauteng, South Africa Manpower Group SA (Pty) Ltd Full timeJob Summary: We are seeking a skilled Claims Resolution Specialist to join our team at Manpower Group SA (Pty) Ltd. As a Claims Resolution Specialist, you will be responsible for validating and administering client claims following a fortuitous event.Key Responsibilities:Validate and administer client claims in accordance with Standard Operating Procedure...
-
Insurance Claims Specialist
4 weeks ago
Johannesburg, Gauteng, South Africa CFS Recruitment Full timeJob Title: Binder & Outsourced Claims SpecialistCFS Recruitment is seeking a highly skilled Binder & Outsourced Claims Specialist to join our team. As a key member of our insurance team, you will be responsible for managing claims and ensuring that our clients receive the best possible service.Key Responsibilities:Manage claims from inception to closure,...