Claims Assessor

6 months ago

Pretoria, South Africa Qetello Holdings Full time

About Our Client: Our client is a leading medical scheme based in Pretoria, dedicated to providing comprehensive healthcare benefits to its members. They are committed to innovation, quality service, and the well-being of their clients. In line with their growth and commitment to excellence, they are seeking a dedicated and experienced Claims Assessor to ensure that all claims are assessed accurately and paid correctly in accordance with the clients benefit and tariff structures. The successful candidate will have a minimum of 2 years of claims assessing experience in the Medical Aid industry.

Functions:

  • Assess all claims using the appropriate rules and guidelines.
  • Ensure accurate and timely processing of claims.
  • Verify claim details and documentation for accuracy and completeness.
  • Liaise with healthcare providers and members to resolve any claim-related queries or issues.
  • Adhere to the client's benefit and tariff structures while processing claims.
  • Maintain accurate records of all claims assessments and payments.
  • Provide excellent customer service to members and healthcare providers.
  • Assist with other administrative tasks as required.

 

Skills:

  • Ability to handle stressful situations appropriately
  • Ability to write complex sentences, using proper punctuation, and using adjectives and adverbs.
  • Excellent customer service skills (including questioning, probing, listening, establishing rapport, matching and closing)
  • Excellent data entry and typing skills
  • Excellent written and verbal communication skills. Creates an atmosphere in which timely and high-quality information flows smoothly to colleagues at all levels, within or external of the organisation; encourages open expression of ideas and opinions.
  • Interpersonal Skills - Thinks carefully about the likely effects on others of one's words, actions, appearance, and mode of behaviour. Selects the words or actions most likely to have the desired effect on the individual or group in question.
  • Listening skills - the ability to accurately receive and interpret messages in the communication process.
  • Negotiation skills - Explores positions and alternatives to reach outcomes that gain acceptance of all parties.
  • Proactive problem solving and conflict management - Builds a logical approach to address problems or opportunities or manage the situation at hand by drawing on one's knowledge and experience base and calling on other references and resources as necessary.
  • Soft Skills in Customer Service; Knowledge of customer service principles and practices
  • Superior listening, verbal, and written communication skills
  • Time management skills - the ability of planning and exercising conscious control of time spent on specific activities, especially to increase effectiveness, efficiency, and productivity.

Requirements:

  • Grade 12 qualification.
  • Minimum of 2 years' experience in claims assessing within the Medical Aid industry.
  • Strong computer literacy, including proficiency in Microsoft Office applications.
  • Excellent administration skills with a keen eye for detail.
  • Good customer service skills with the ability to listen and communicate effectively.
  • Ability to work efficiently in a fast-paced environment.
  • Strong analytical and problem-solving skills.

Remuneration:

  • Competitive salary commensurate with experience.
  • Exceptional benefits program including 23 days of annual leave, 8-hour workday with a 30min break, life cover, disability benefits, funeral cover, pension fund, medical aid, and more.
  • Office perks: free parking, Wi-Fi, landline phone allowance, on-site gym, subsidized meals, free refreshments, Athletics Club, Pilates, and wellness programs.
  • Dynamic team interactions, recognition programs, and incentives.

Join Our Client: Be part of a team that values innovation, quality service, and the well-being of its members. Apply today to contribute to a leading medical scheme's success and make a difference in the lives of many.

Application Process: Interested candidates should submit their CV and cover letter, highlighting their experience related to the job functions and skills listed above to recruitment1@medicalresources.co.za .

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