HEALTHCARE CLAIMS ADJUSTOR

WE'RE HIRING | HEALTHCARE CLAIMS ADJUSTOR | U.S. HEALTH BENEFITS ADMINISTRATION

HEYA Solutions South Africa is looking for an experienced Healthcare Claims Adjustor to join our growing healthcare support team.

This role is for someone who already understands U.S. healthcare claims processing, medical coding, benefit plan administration, and who is ready to support a U.S.-based health benefits administrator working with self-funded employer groups.

WHAT YOU'LL DO

• Reviewing and assessing incoming healthcare claims for accuracy and completeness
• Adjudicating claims and processing payment to providers in line with Benefit Plan rules
• Working closely with the Claims Supervisor, Account Managers, System Configuration, and Quality Assurance teams
• Ensuring claims are processed accurately and within required turnaround times
• Applying knowledge of medical coding and benefit plan rules to claims decisions
• Managing multiple claims and priorities in a fast-paced, deadline-driven environment
• Working independently for the majority of the day while staying aligned with team standards
• Escalating and flagging issues, discrepancies, or system configuration concerns where needed
• Maintaining accurate records within proprietary claims processing systems

WHO WE'RE LOOKING FOR

• Experience with claims processing systems is required; HealthRules Payer experience is strongly preferred.
• Knowledge of healthcare claims, medical coding, and Benefit Plan rules.
• Strong critical thinking skills and the ability to make sound, independent decisions.
• Excellent written and verbal communication skills.
• Ability to manage multiple issues at once within a fast-paced environment with production schedules and deadlines.
• Comfortable working independently for most of the day.
• Proficiency in Microsoft Office and web-based software, with the ability to learn proprietary computer systems.
• High School diploma or GED required.

Location: Johannesburg, South Africa (IN-OFFICE)

Position: Full-Time

Working Hours: US Business Hours

If you understand U.S. healthcare claims and are looking for an opportunity to become part of an international healthcare operation, we'd be excited to hear from you and explore the next steps.

Interested in joining our team? Apply directly through LinkedIn, or send your CV to ***email_hidden*** with the subject line: Healthcare Claims Adjustor.

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