Claims Assessor and Medical Aid Specialist

1 week ago


Durban, KwaZulu-Natal, South Africa Momentum Full time

Job Overview

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Momentum is seeking a skilled Claims Assessor to join our team in processing medical aid claims efficiently and accurately. The ideal candidate will have comprehensive knowledge of medical aid assessing procedures and experience working on the Oracle platform.

Duties and Responsibilities

  • Capture and process incoming medical aid claims within agreed time frames.
  • Assist cross-functionally in the claims department as needed.
  • Process claims according to predetermined standards and business processes on the Oracle platform.
  • Perform claims validation in accordance with legislation and scheme rules.
  • Conduct quality control to minimize error rates.
  • Work on reports and provide insights for departmental improvements.

Requirements

  • Matriculation certification.
  • Computer literacy.
  • Comprehensive knowledge of medical aid assessing procedures.
  • Experience working on the Oracle platform is an advantage.
  • A minimum of 2-3 years' experience as a claims assessor is an advantage.
  • Industry knowledge of BHF, Tariff Guide, SAMA, and ICD10 codes is an advantage.


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