Claims Assessor

2 weeks ago

Bellville, South Africa Momentum Health Full time

**Introduction**
- Momentum Health, an entity of Momentum Group ,delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximize lifetime client value. We build and maintain a culture of innovation, and create value through unique insights into how to achieve specific outcomes by using a defined set of Health capabilities.

**Disclaimer**
- As an applicant, please verify the legitimacy of this job advert on our company career page.

**Role Purpose**
- Assess, review and manage medical scheme claims, in accordance with relevant legislation and company policy, adhering to service level agreements and meeting client and business expectations.

**Requirements**:

- Grade 12 or equivalent qualification - (Essential)
- Relevant degree or qualification - (Desirable)
- 1-2 years experience in processing medical scheme claims (Desirable)
- Experience in the assessing of relevant medical scheme claims, paper and/or EDI - (Desirable)
- Knowledge of relevant legislation and industry regulations
- Knowledge of the claims assessment process - (paper and EDI)
- Knowledge of the relevant scheme or product rules
- Knowledge of ICD coding (Desirable)

**Duties & Responsibilities**
- INTERNAL PROCESS
- Accurately capturing and assessing of medical scheme claims within the required timeframes.
- Advise on and contribute to the development of procedures and processes within area of specialisation for continued quality and service improvement.
- Assist with continuous improvement efforts through the identification of opportunities, cost reduction, improvement on the quality of claims decisions and systems enhancement.
- Provide insight, knowledge, assistance and testing support where necessary as part of the development and maintenance of claims systems to improve quality and efficiency.
- Provide accurate and timeous reporting, analysis and insights on claims assessed as and when required.

CLIENT
- Build and maintain relationships with clients and internal and external stakeholders
- Deliver on service level agreements made with clients and internal and external stakeholders in order to ensure that client expectations are managed.
- Make recommendations to improve client service and fair treatment of clients within area of responsibility.
- Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.

PEOPLE
- Develop and maintain productive and collaborative working relationships with peers and stakeholder.
- Positively influence and participate in change initiatives.
- Continuously develop own expertise in terms of professional, industry and legislation knowledge.
- Contribute to continuous innovation through the development, sharing and implementation of new ideas.
- Take ownership for driving career development.

FINANCE
- Contribute to the financial planning process within area.
- Identify opportunities to enhance cost effectiveness and increase operational efficiency.
- Manage financial and other company resources under your control with due respect.
- Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

**Competencies**
- Examining Information
- Interacting with People
- Managing Tasks
- Documenting Facts
- Making Decisions
- Producing Output
- Interpreting Data
- Meeting Timescales

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