Claims Assessor
10 hours ago
-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
Assess and process medical aid claims as per Claims procedures.
Requirements
- Matric
- Computer literate
- Comprehensive knowledge of all aspects of medical aid assessing is essential
- Working on the Oracle platform is an advantage.
- A minimum of 2 - 3 years' experience as a claims assessor is an advantage.
- Industry knowledge (BHF; Tariff Guide; SAMA, ICD10 codes) is an advantage
Duties & Responsibilities
- Accurately capture and process all incoming medical aid claims (paper, EDI, real time, workflow) within agreed timeframes
- Processing of claims according to predetermined standards and business processes on the Oracle platform.
- Ensure that claims validation is performed in accordance with legislation and scheme rules
- Quality control to ensure error rate is minimised
- Work on KRIS reports / departmental reports
- Pay claims correctly the first time and on time to members or service providers thereby reducing repeat queries and escalations
Competencies
- Attention to detail and accuracy
- Problem solving ability
- Ability to function effectively within a team
- Ability to work under pressure
- Consistently works to meet expectations
- Resolves client problems within his or her job scope
- Is engaged and demonstrates energy in the execution of tasks
- Accepts accountability for own mistakes and ensures corrective action is taken
- 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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