Medical Claims Adjudicator

1 week ago


Sandton, South Africa HR Studio Ltd Full time
Job Title: Medical Claims Adjudicator

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].

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