Query Resolution Officer

2 weeks ago

Bellville, South Africa Health Solutions Full time

**Introduction**

Momentum Health, an entity of Momentum Metropolitan Limited, 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.
This vacancy is based at our Bellville office, in Cape Town.

**Role Purpose**

To ensure a professional and consistent customer service delivery through the resolution of escalated Medical Aid queries.

**Requirements**:

- Matric/ Grade 12
- Minimum 2 years of Medical Aid Claims Assessing experience essential
- Proven experience in the assessing of Medical Aid claims (paper and/or EDI) essential
- Excellent literacy, numeracy and communication skills
- Multi discipline claims knowledge
- Good knowledge of PMB at industry level as well as in house PMB processes
- 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 claims 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**
- 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 tasksAccepts accountability for own mistakes and ensures corrective action is taken

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