Medical Aid Claims Administrator - Sandton Verfied Gold Badge

R 16000 per month Sandton, Gauteng Sandton, Gauteng more than 14 days ago 08-06-2017 8:19:01 AM
03-08-2017 8:19:01 AM
Medical Aid Claims Administrator – Bryanston – R12 to R16 000.00

We have a new vacancy available for an experienced medical aid claims administrator based at our client in Bryanston. Excellent working environment and career prospects at this forward thinking and dynamic organisation.
Technical knowledge of various insured products, good understanding and knowledge of ICD codes, procedure codes and South African Medical Aid Schemes, assessment of claims, extensive liaison with brokers/client and groups. Must be proficient in Afrikaans

Duties:
Assessment of claims:
Claims received must be date stamped, entered onto the appropriate system and a number allocated on a daily basis, Ensure that the correct claim form is completed duly and signed by the claimant/member, Check claim for eligibility, Check that the claim has been numbered, Check that the claim has not been duplicated, Check the claim for missing accounts/documents, Contact the member/client group/broker and request the missing accounts/documents, Write to the member/client/broker, acknowledge receipt of claim and request the outstanding accounts/documentation, Make a note on the claim of any telephonic conversation with member, doctor, medical aid or hospital/participating company
? Process the claim as per the table of benefits, Ensure that all benefit entries are within and during the hospitalisation period if applicable
? Ensure that all benefit entries are as per the rules/stipulations of the guide to fees if applicable, Ensure that all benefit entries are as per the Policy wording, Ensure that all limitations are applied, Ensure that the calculations/limitations/fixed benefits are as per the applicable option, Recheck the claim for possible calculation errors
? Attend to client queries, both telephonically and in writing

Industry knowledge, underwriting, compliance, NHRPL or similar guidance on pricing/medical aid tariffs is essential.
*Good contactable previous employment references, minimum 5 years previous experience as a medical aid claims administrator, clear criminal/ ITC record and fluency in Afrikaans is essential.*