Claims Specialist

1 week ago

Durban, South Africa Momentum Metropolitan Holdings Full time

-Introduction

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
Role Purpose

To ensure a professional and consistent customer service delivery through the resolution of escalated queries.
Requirements
- Matric or Grade 12
- 3 - 4 years claims assessing experience
- Excellent literacy, numeracy and communication skills
- Multi discipline claims knowledge
- Good knowledge of Health Risk processes will be an advantage
- Completion of Medical Assessing Course will be an advantage
- Proven experience in the assessing of medical aid claims(paper and/or EDI) will be advantageous
- Passionate about driving a high performance culture
- Knowledge of the NHRPL- National Health Reference Price List (Previously Known as BHF) and SAMA Tariffs
Duties & Responsibilities
- Accurate and timeous resolution of Claims Queries
- Correctly reverse and reprocess the related claim
- Ensuring that no duplicate claim are paid during the process
- Appropriate pay code is applied
- Assisting other departments with claims related queries
- Liaising with other departments to resolve queries
- Recording all queries and interactions with customers onto the workflow system.
- High quality and service output
Competencies
- Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
- Anticipates, meets and exceeds client’s needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
- Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
- Actively leads change, does what is right for the business and drives continuous improvement through innovation.
- Creates and maintains an open, positive working environment by generating commitment, building trust, a shared sense of purpose, empowerment in others and encouraging them to contribute to the best of their ability.
- Prioritises the business interests of MMH and invests in the success of the group by aligning effort across divisions.
- Persuades, convinces, influences and inspires others, both within MMH and externally to win support, loyalty and gain commitment to the purpose of MMH.
- Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
- Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
- Takes responsibility for own development; and actively mentors, coaches and develops talent in others. Builds leadership bench strength for MMH by providing opportunities and experiences to develop skills, competencies and business knowledge.
- Policy

We are committed to Employment Equity, diversity and inclusion when recruiting internally and externally. All appointments are made in alignment to our Employment Equity goals and we encourage people with disabilities to apply.

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