Job Description

Closing Date 2025/02/07
Reference Number MMH250122-7
Job Title Claims Assessor
Position Type Permanent
Role Family Client Services
Cluster Health Solutions
Remote Opportunity None of the time
Location - Country South Africa
Location - Province Eastern Cape
Location - Town / City Gqeberha
IntroductionMomentum Health, an entity of the Momentum Group, 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.
Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.
Role PurposeTo effectively contribute to the Claims Team, ensuring that the Teams key performance indicators and the Schemes service level agreements are met by accurately inserting and assessing claims according to protocol.
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 business-related degree or diploma is preferred
• A minimum of 1 years experience in an administrative role is required
• Prior experience in a medical scheme administrative environment is preferred
• Familiarity with medical claims processing and ICD-10 coding is highly advantageous
• Proficiency in the Microsoft Office Suite is essential

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.

Competencies

• Accountability
• Time management
• Attention to detail
• Teamwork and cooperation
• Business administration skills

PolicyWe 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.

Momentum Group