Claims Specialist MMH250707-15

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 and 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.
  
  

As an applicant, please verify the legitimacy of this job advert on our company career page.-346021296