Medical Claims Validator

2 days ago

Pretoria, Gauteng, South Africa Medical Resources Group (Pty) Ltd Full time R200 000 - R400 000 per year

Together with our client, a leading claims administrator in Pretoria East, we are recruiting for a Medical Claims Validator to join their team. The ideal candidate needs to have minimum 2 years Medical claims related experience and must have matric/grade 12.

Duties and Responsibilities:

Operational:

  • Assess COID claim information
  • Assess billing on account per item in terms of COID Gazette
  • Assess accounts against payment history received from COID
  • Practice management of assigned practices
  • Effective communication with assigned practices
  • Assisting with client support and operational queries on accounts submitted;
  • Provide medical advice and/or direction on claims to clients;
  • Following up on outstanding information required from clients and employers for processing of medical claims and invoices;
  • Resolve enquiries from clients related to the COID Act and medical treatment of patients;
  • Contribute to daily operations; and
  • Endure that all procedures are followed and that all production goals are met.
  • Adhere to production deadlines.
  • Assist to accomplish set revenue targets.
  • Assist with training of newly appointed staff in the same division.
  • Updating DS system with the relevant claim numbers from the Compensation Fund system.
  • Upload of medical reports in the prescribed format on the Compensation Fund system.
  • Assist in other areas of the department where required

Ad-hoc:

  • As a team member add value and contribute to the company;
  • Assist to accomplish set revenue targets;
  • Show willingness to adapt to industry and company changes;
  • Show positive attitude towards your job, colleagues and clients;
  • Be willing to share knowledge, do training and comply with set company policies; and
  • Assist in other areas of the department where required

Minimum Qualifications and Education Requirements:

  • Matric / Grade 12;
  • Tertiary qualification will be beneficial;
  • Experience in Client and Funder Communication essential; and
  • Medical claims related experience will be essential.

Preferred Skills, Competencies & Personal Traits:

  • Computer literate in MS Office (Microsoft Excel, Word, and Outlook)
  • Articulate with strong communication skills (oral and written);
  • CompEasy / Exempt funders / Medical claims online systems will be beneficial;
  • Exhibits an inquisitive nature and a proactive, problem-solving attitude;
  • Ability to adapt and learn new skills;
  • Ability to multitask; and
  • Cope well under pressure.

Remuneration

  • Market related - depending on experience

Only candidates who meet all the requirements stipulated in this advert will be considered. If you don't receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

To apply please send your CV and supporting documents to with REF: Validator

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