Claims Specialist
7 days ago
-Introduction
Metropolitan is one of the oldest financial services brands in South Africa. With a 116-year legacy of serving the communities in which it operates, Metropolitan represents true empowerment in serving Africa’s people through affordable financial solutions that create financial growth and security. Metropolitan operates in South Africa, but the brand is also present in 12 African countries including, Namibia, Botswana, Kenya, Ghana, Nigeria, Lesotho, and Swaziland.
Role Purpose
To provide an effective and efficient service to clients by receiving, evaluating, and responding to inquiries timeously.
Requirements
- Grade 12/Matric.
- 3 - 4 years' claims-related experience within a medical aid administration environment.
- Computer Literacy (i.e. E-mail, Word and Excel).
- Thorough knowledge of the MH claims operating system.
- Experience in electronic and paper claims assessing.
Duties & Responsibilities
- Assessing both EDI and paper claims.
- Liaising with external business partners.
- Providing quality written feedback to claims queries.
- Assisting with claims flows between Business partners.
- E-mail investigations, escalated complaints, and Client service queries.
- Ensure all correspondence is archived and dealt with timeously.
- Provider/member investigation.
- Provider/membership profiling and trend analysis.
- Member verifications (telephonically).
- In-depth understanding of various claims processing methods.
Competencies
- Analytical
- Problem-solving
- Attention to detail
- Effective Communication Skills (verbal and written)
- Ability to work in a fast pace and pressurized environment
- Results-orientated
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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