Medical Claims Processing Specialist

3 weeks ago


Sandton, South Africa HR Studio Ltd Full time

About the Role:

We are seeking a highly skilled Claims Analyst to join our team at HR Studio Ltd.

The ideal candidate will have extensive experience in medical claims processing, including knowledge of medical terminology and working in a production environment.

Key Responsibilities:

  • Review assigned claims or requests from a queue, maintaining 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
  • Achieve and exceed key performance indicators for performance, production, and quality

Requirements:

  • Matric Diploma or equivalent, Bachelor's degree preferred or experience in lieu of degree
  • 2 years of medical claims processing experience, including knowledge of medical terminology and working in a production environment

About Us:

HR Studio Ltd is a dynamic organization that values teamwork, innovation, and excellence. We offer a collaborative and supportive work environment, with opportunities for growth and development.

Working Hours:

After training, the working hours will be from 9am to 6pm.

Training Period:

The training period will be 3-6 weeks, from 2pm to 11pm.



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