Medical Claims Auditor

1 month ago


Cape Town, Western Cape, South Africa Nambiti Technologies Full time
Job Description:

Nambiti Technologies seeks a highly skilled Medical Claims Review Officer to join our team.

About the Role:

This is a challenging and rewarding opportunity for an experienced professional to review medical claims and ensure compliance with company guidelines and regulations.

We are looking for someone who can analyze complex medical data, identify discrepancies, and make informed decisions regarding claim approval or rejection.

Key Responsibilities:
  • Review medical claims for accuracy and completeness
  • Analyze medical data to identify trends and patterns
  • Make recommendations for claim approval or rejection based on company guidelines and regulations
  • Communicate with healthcare providers and patients to clarify any discrepancies
  • Maintain accurate records of claims processing and decision-making
Requirements:
  • Bachelor's Degree in Nursing, Allied Health Professions, or related field
  • Registration with relevant health professions council
  • Minimum 3 years of experience in a medical field
  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills
Competencies:
  • Personal mastery
  • Emotional wisdom
  • Ethics and governance
  • Customer orientation and customer focus
  • Computer literacy
  • Ability to interpret rules of UPFS tariffs
  • Analytical skills
  • Organizational and administrative skills
  • Planning and organizing
  • Decision-making
  • Negotiation skills
Salary:

R 800,000 - R 1,200,000 per annum

Benefits:
  • Opportunity to work with a leading technology company
  • Professional development and growth opportunities
  • Competitive salary and benefits package
  • Collaborative and dynamic work environment


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