Clinical Audit Clerk

2 weeks ago

Cape Town, South Africa Health Solutions 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.

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

**Role Purpose**
- To provide an effective and efficient service to clients by receiving, evaluating and responding to Medical Aid claims queries timeously.

**Requirements**:

- Matric
- Relevant tertiary qualification would be advantageous
- 3 - 5 years in the medical aid industry is essential
- 2 - 3 years Claims processing and query management experience within the medical aid industry is essential
- Claims School training is essential

**Duties & Responsibilities**
- Identifying risks and possible anomalies to the company and escalate accordingly.
- Maintaining a consistent service delivery to ensure client retention and satisfaction.
- Ensuring Service Level Agreements are met and exceeded at all times.
- Providing first time resolution on queries of a complex nature.
- Dealing promptly with client requests in a competent, efficient and professional manner.
- Driving and supporting effective teamwork within the department.
- Engaging in appropriate training interventions to promote own professional development.
- Recording of all queries and interactions with customers onto the workflow and reflection systems.
- Liaise with the Clinical Advisors i.e. Medical Advisors, Radiologist, Pathology accordingly.
- Collaborate with relevant departments in ensuring resolution to complex queries.
- Provide clinical interpretation and appropriateness of claims in accordance with Scheme Rules. Positively influence and participate in change initiatives.**Competencies**
- Good written and verbal communication
- Business Acumen
- Client/ Stakeholder Commitment
- Drive for Results
- Leads Change and Innovation
- Collaboration
- Impact and Influence
- Works independently
- Diversity and Inclusiveness

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