Current jobs related to Medical Claims Adjudicator - Sandton - HR Studio Ltd
-
Medical Claims Examiner
2 months ago
Sandton, South Africa HR Studio Full timeWe're seeking a skilled Medical Claims Examiner to join our team at HR Studio. As a Claims Analyst, you will be responsible for providing timely and accurate processing and adjudication of claims.About the RoleYou will be part of a dynamic team responsible for reviewing assigned claims or requests from a queue, maintaining a set inventory level. Your key...
-
Medical Claims Specialist
3 weeks ago
Sandton, South Africa HR Studio Ltd Full timeJob DescriptionAs a Medical Claims Specialist at HR Studio Ltd, you will play a crucial role in ensuring timely and accurate processing and adjudication of claims. The ideal candidate will have a strong eye for detail, excellent communication skills, and the ability to work effectively in a fast-paced production environment.About the RoleWe are seeking a...
-
Medical Claims Professional
3 weeks ago
Sandton, South Africa HR Studio Ltd Full timeCompany Overview:\Helpers Studio Ltd is a leading provider of innovative solutions in the field of medical claims processing. Our company prides itself on its commitment to excellence and customer satisfaction. \Salary:\$60,000 - 80,000 per year, depending on experience \Job Description:\\\\The ideal candidate will be responsible for the timely and...
-
Medical Claims Processing Specialist
1 month ago
Sandton, South Africa HR Studio Ltd Full timeWe are seeking a skilled Medical Claims Processing Specialist to join our team at HR Studio Ltd. This is an exciting opportunity for an experienced claims professional to take their career to the next level.Job Summary:The ideal candidate will have a strong background in medical claims processing, including knowledge of medical terminology and experience...
-
Claims Expert
3 weeks ago
Sandton, South Africa HR Studio Ltd Full timeJob OverviewWe are seeking an experienced Medical Claims Specialist to join our team at HR Studio Ltd.This is a unique opportunity to work in a dynamic environment where you will be responsible for processing and adjudicating medical claims efficiently and accurately.
-
Claims Administrator
3 weeks ago
Sandton, South Africa HR Studio Ltd Full timeJob Title: Claims AdministratorWe are seeking a skilled and detail-oriented Claims Administrator to join our team at HR Studio Ltd. As a key member of our claims processing team, you will be responsible for ensuring the timely and accurate processing of medical claims.**Job Description:**The successful candidate will have a strong understanding of medical...
-
Claims Analyst
5 months ago
Sandton, South Africa HR Studio Full timeWe're looking for… A Claims Analyst that will provide timely and accurate processing and adjudication of claims. You will be doing research, and processing claims or related requests for covered members or providers across various products including medical, pharmacy, vision and related healthcare options. Who are you? ...
-
Medical Claims Negotiator
1 month ago
Sandton, South Africa HR Studio Ltd Full timeWe are seeking a highly skilled Medical Claims Negotiator to join our team at HR Studio Ltd. As a key member of our healthcare industry team, you will play a crucial role in negotiating medical claims on behalf of our clients.The ideal candidate will have excellent communication and negotiation skills, with the ability to work effectively with out-of-network...
-
Claims Expertise Specialist
4 weeks ago
Sandton, South Africa HR Studio Ltd Full timeWe 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...
-
Claims Specialist
4 weeks ago
Sandton, South Africa HR Studio Full timeAbout HR StudioAt HR Studio, we are committed to delivering exceptional service to our clients. Our team is dedicated to providing timely and accurate processing and adjudication of claims.
-
Medical Claims Specialist
2 months ago
Sandton, South Africa PPS Recruitment Full timeSenior Medical Assessor RoleThe successful candidate will be responsible for managing claims in accordance with policy terms and conditions. They will be accountable for claims processes and procedures, and will work with stakeholders to develop return to work plans as needed. The ideal candidate will have a strong understanding of claims management and will...
-
Out-of-Network Claims and Negotiations Coordinator
3 months ago
Sandton, South Africa HR Studio (Pty) Ltd Full timeWe’re looking for… A Provider Contracting and Negotiating Specialist who will be responsible for working on behalf of the client to negotiate their out of network claims when applicable. You will work directly with out of network providers to work out a single case agreement/fee or direct contract for submitted medical claims. Who are you? - You can...
-
Senior Medical Claims Specialist
1 month ago
Sandton, South Africa HR Studio Full timeAbout the RoleWe're seeking a highly skilled and experienced Senior Medical Claims Specialist to join our team at HR Studio. This is a challenging opportunity for an individual with excellent negotiation and communication skills to work closely with out-of-network providers to secure cost-effective service delivery.
-
Claims Assessor
6 months ago
Sandton, South Africa Guardrisk Full time**Introduction** Processing of medical expense shortfall (gap cover) claims in accordance with stipulated service levels and in terms and conditions of cover as defined in policy wording. **Role Purpose** Processing of medical expense shortfall (gap cover) claims in accordance with stipulated service levels and in terms and conditions of cover as defined...
-
Claims Consultant
7 months ago
Sandton, South Africa Moving Heads Personnel Full time**EXEPERIENCE IN THE FINANCIAL SERVICES INDUSTRY/LIFE INSURANCE ESSENTIAL** - Responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims. - Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge, and experience...
-
Claims and Underwriting Administrator
3 months ago
Sandton, South Africa Discovery Ltd. Full time**Business Unit**:Discovery Employee Benefits**Function**:Claims Administration**Date**:4 Oct 2024 - Achieve more than** **YOU BELIEVE** - Discovery Corporate & Employee Benefits- Claims and Underwriting Administrator**About Discovery** - Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in...
-
Claims Manager
2 weeks ago
Sandton, South Africa Oneplan Underwriting Managers (Pty) Ltd. Full time**Purpose of the Role**: **Key Responsibilities**: **Full Management of the of the Authorisations Teams (Health and Pet)**: - Define the claims strategy that can be cascaded down for successful implementation across the claims function. - Structure the Claims department to enable high-level claims analysis to be carried out and successfully interpreted by...
-
Group Risk Claims Consultant
7 months ago
Sandton, South Africa Moving Heads Personnel Full time**EXPERIENCE IN THE FINANCIAL SERVICES/LIFE INSURANCE INDUSTRY ESSENTIAL** Responsible to drive the formulation and implementation of the risk model and underwriting philosophy, analyse claims and other data when assessing claims. Providing feedback on all claims, liaising with relevant stakeholders, and utilise their skills, knowledge and experience to...
-
Disability Claims Assessor
3 months ago
Sandton, South Africa Discovery Ltd. Full time**Business Unit**:Discovery Employee Benefits**Function**:Clinical**Date**:11 Oct 2024 - Achieve more than** **YOU BELIEVE** - Discovery Corporate & Employee Benefits- Disability Claims Assessor**About Discovery** - Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals...
-
Claims Assessor Specialist
3 months ago
Sandton, South Africa Discovery Ltd. Full time**Business Unit**:Vitality Life**Function**:Claims Administration**Date**:11 Oct 2024Discovery - VitalityLife - Claims Assessor - Specialist - About Discovery VitalityLife - Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core...
Medical Claims Adjudicator
2 months ago
About the Role:
We are seeking a skilled Medical Claims Adjudicator to join our team at HR Studio Ltd. The successful candidate will be responsible for the timely and accurate processing and adjudication of medical claims.
Key Responsibilities:
- Review assigned claims or requests from a queue and maintain a set inventory level.
- Analyze claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract, and/or policy.
- Perform claim rework, medical reviews, or other assigned projects as needed.
- Identify and report inaccuracies in adjudication related to system configuration, benefit inconsistencies, and fee schedules.
- Efficiently and accurately analyze medical claims to determine approval or denial for payment based on plan or client conditions.
- Resolve pending healthcare claims and prior approval requests.
- Assist other departments by contributing to projects, providing feedback, conducting research, and resolving inquiries related to claims adjudication.
Requirements:
- Matric Diploma or equivalent, Bachelor's degree preferred or experience in lieu of degree.
- 2 years of medical claims processing including knowledge of medical terminology and working in a production environment.
- Ability to work overtime as required, including weekends.
What We Offer:
- Competitive salary and benefits package.
- Opportunities for career growth and development.
- Collaborative and dynamic work environment.
How to Apply:
Please submit your application, including your resume and cover letter, to [insert contact information].
