Claims Assessor

4 weeks ago


Pretoria, Gauteng, South Africa Qetello Holdings Full time
About Our Client

Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients.

Job Summary

We are seeking a dedicated and experienced Claims Assessor to ensure that all claims are assessed accurately and paid correctly in accordance with the client's benefit and tariff structures.

Key Responsibilities
  • Assess all claims using the appropriate rules and guidelines.
  • Ensure accurate and timely processing of claims.
  • Verify claim details and documentation for accuracy and completeness.
  • Liaise with healthcare providers and members to resolve any claim-related queries or issues.
  • Adhere to the client's benefit and tariff structures while processing claims.
  • Maintain accurate records of all claims assessments and payments.
  • Provide excellent customer service to members and healthcare providers.
  • Assist with other administrative tasks as required.
Requirements
  • Grade 12 qualification.
  • Minimum of 2 years' experience in claims assessing within the Medical Aid industry.
  • Strong computer literacy, including proficiency in Microsoft Office applications.
  • Excellent administration skills with a keen eye for detail.
  • Good customer service skills with the ability to listen and communicate effectively.
  • Ability to work efficiently in a fast-paced environment.
  • Strong analytical and problem-solving skills.
What We Offer
  • Competitive salary commensurate with experience.
  • Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.
  • Office perks: free parking, Wi-Fi, landline phone allowance, on-site gym, subsidized meals, free refreshments, Athletics Club, Pilates, and wellness programs.
  • Dynamic team interactions, recognition programs, and incentives.

Join our client and be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme's success and make a difference in the lives of many.



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