Medical Aid Claims Examiner

1 week ago


Durban, KwaZulu-Natal, South Africa Momentum Full time

**About the Role**

Momentum, a leading health insurance company, is seeking an experienced Claims Assessor to join our team. As a Claims Assessor, you will play a crucial role in processing medical aid claims accurately and efficiently.

Key Responsibilities:

  • Achieve high accuracy rates when capturing and processing incoming medical aid claims within agreed time frames.
  • Collaborate with cross-functional teams in the claims department to ensure seamless claim processing.
  • Process claims according to predetermined standards and business processes on the Oracle platform.
  • Ensure claims validation is performed in accordance with legislation and scheme rules.
  • Conduct quality control checks to minimize error rates.
  • Analyze KRIS reports and departmental reports to identify trends and areas for improvement.
  • Prioritize and manage multiple claims simultaneously to meet deadlines.

Requirements:

  • Degree or equivalent qualification (Matric)
  • Proficiency in computer systems and software (Computer literate)
  • In-depth knowledge of medical aid assessing principles and industry regulations
  • Working experience with the Oracle platform is advantageous
  • Minimum 2-3 years' experience as a claims assessor or related field
  • Familiarity with BHF, Tariff Guide, SAMA, ICD10 codes, and other relevant industry standards


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