Claims Specialist

Introduction Momentum Health Solutions, an entity of Momentum Metropolitan Holdings 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 Purpose To provide an effective and efficient service to clients by receiving, evaluating, and responding to enquiries timeously

Requirements

• Matric
• Tertiary qualification (advantageous).
• Claims School training is essential.
• Computer Literacy (i.e. E-mail, Word, and Excel) is essential.
• Experience in claims assessing is essential.
• Knowledge of PMB process (advantageous)
• 1 - 3 years of experience in the medical aid industry is essential.
• 2 - 3 years of Claims processing experience within the medical aid industry is essential.
• 2 – 3 years of query management or client service experience is essential.
• Good understanding of the Momentum Health systems would be advantageous.
• Good written and verbal communication.
• Understanding and knowledge of the interpretation and application of CMS, Department of Health, BHF, Private hospitals, etc., (advantageous).

Duties & Responsibilities

• Identifying risks to the company and escalating accordingly.
• Assessing medical aid claims.
• Engage in effective communication and delivery according to service levels.
• Maintaining a consistent service delivery to ensure client retention and satisfaction.
• Driving and supporting effective teamwork within the department.
• Engaging in appropriate training interventions to promote own professional development.
• Demonstrate the company's values on a daily basis.
• Recording of all queries and interactions with customers onto all applicable systems.
• Escalate client queries to the relevant department or stakeholder via the applicable channel.
• Collaborate with relevant departments to ensure the resolution of queries.
• Develop and maintain productive and collaborative work relationships with peers and stakeholders.
• Positively influence and participate in change initiatives.

Competencies

• Arithmetic, data interpretation, and problem-solving using mathematical reasoning
• Continuously develop own expertise in terms of professional, industry, Scheme and legislation knowledge.
• Identify opportunities to enhance cost-effectiveness and increase operational efficiency
• Business Acumen
• Client/ Stakeholder Commitment
• Drive for Results
• Leads Change and Innovation
• Collaboration
• Impact and Influence
• Works independently
• Diversity and Inclusiveness