Claims Consultant

Job Advert Summary

Recruiting for a seasoned claims assessor to analyze, reconcile, process information on a Claims account. The successful candidate should be able to assess various type of claims submitted electronically / paper or received via fax or e-mail ensuring high quality standards.

Minimum Requirements

Grade 12

2 yrs + Medical Aid Administration experience

2 yrs + Medical claims assessing experience

Computer Literacy

Duties and Responsibilities

Reconcile member or provider claims received.

Accurate daily assessing of targets.

Manage quality error percentage.

Ensure consistent and excellent application of set standards and Scheme Rules.

Excellent administrative skills e.g. daily record keeping.

Escalate requests for corrections to relevant Consultant.

Follow up and resolve routed enquiries.