Claims Administrator

6 days ago

Cape Town, South Africa Workability Pty Ltd Full time

**About us**

Workability is a market-leading administrative health care company that has pioneered multidisciplinary rehabilitation in South Africa. Workability uses innovative technology and evidence-based clinical protocols to streamline the process of getting injured patients back to work and life, thereby directly reducing the cost to all stakeholders of absenteeism, injury, and disability. Workability has a growing national network of independently owned physio
- and occupational therapy practices as medical service providers. This particular position will be in the conservative care back and neck rehabilitation claims management department.

**Main Duties & Responsibilities**
- Screening of patient self-referrals for appropriateness to enrol in the program
- Patient pre-authorisation request submission and follow up with funders
- Patient case creation on our bespoke IT platform and communication with the clinical service providers about new referrals
- Monitoring of patient treatment progress and communication with service providers accordingly to ensure treatment protocol timelines are being followed
- Monitoring of clinical quality assurance or administrative requirements to ensure patients claims can be processed successfully for invoicing to funders
- Investigating and resolving non-compliance issues with service providers
- Investigating and resolving rejected claims with funders
- Develop and maintain professional relationships with the funders and service providers
- Generation and interpretation of funder and service provider reporting
- Any other general administrative tasks related to your function

**Required Qualifications & Experience**
- Matric - Grade 12
- At least 5 years of experience in a working environment, in an administrative capacity.
- Medical aid claims experience
- Computer literate with in-depth knowledge and experience with MS Office Suite
- Excel knowledge and experience at intermediate level is a must

**Desirable Attributes**
- Collaborative team player with a proactive mindset.
- Adaptable and flexible to work effectively in a dynamic environment.
- Have a learning mindset and be self-motivated to create your own growth pathways.
- Thrives on producing top-quality outcomes in fast-paced circumstances.
- Focused on effectiveness.
- Pays attention to detail and adheres to deadlines.
- Excellent organizational skills with ability to manage multiple projects

Strong communication skills and ability to work collaboratively

Pay: R15 000,00 - R18 000,00 per month

**Location**:

- Cape Town, Western Cape (required)

Work Location: Remote

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