Temporary Medical Claims Assessor

1 week ago

Port Elizabeth, Eastern Cape, South Africa Momentum Group Limited Full time R250 000 - R400 000 per year
Introduction

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.



Role Purpose

To effectively contribute to the Claims Team, ensuring that the Team's key performance indicators and the Schemes' service level agreements are met by accurately inserting and assessing claims according to protocol.



Duties & Responsibilities
  • Ensure precise insertion and assessing of claims, adhering to the defined service level agreements (SLAs) and ensuring all steps are completed accurately within the designated timeframes.
  • Action all claims-related adjustments based on journal instructions received from various departments.
  • Provide professional, responsive assistance to clients and other key stakeholders by addressing and resolving claims-related inquiries, ensuring that all interactions are conducted in line with the specified service level agreements and meet established quality standards.
  • Identify and escalate any claims-related queries that require additional investigation or further attention to the appropriate team leader, ensuring a timely and efficient resolution.
  • Conduct regular and detailed reporting and analysis of claims data.
  • Perform necessary corrections to claims following investigation, ensuring adjustments are made accurately and in accordance with established protocols and guidelines.


Requirements
  • It is essential to have a National Senior Certificate (Bachelor's pass with Mathematics or Mathematical Literacy as a Grade 12 subject highly advantageous)
  • A minimum of 1 years' experience in an administrative role is essential (medical scheme environment is highly advantageous)
  • Prior experience in a medical scheme claims assessing environment is preferred
  • Proficiency in MS 365 is essential 


Competencies
  • Accountability
  • Time management
  • Attention to detail
  • Teamwork and cooperation
  • Business administration skills
  • Examining information
  • Interpreting data
  • Analysing information

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