Established company in managed healthcare is looking for a experienced Claims Assessor. Must have worked and have experience in a medical aid within Claims Department.

The purpose of this position is to ensure that all claims are assessed using the appropriate rules and is paid correctly in line with the company benefit and tariff structures

Duties:

Assess validity of claims using the relevant Scheme rules, NHRPL, Industry rules etc

Ensure that claims are paid correctly within agreed timeframes and according to the Scheme Rules
Resolve member and provider queries
Complete production forms on a daily basis and report required statistics

Minimum Requirements:

Grade 12
Claims assessing experience
ICD10 and coding experience
Excessive claims experience and knowledge within a medical aid environment
Microsoft Word

Skills:

Information, Processes and Systems

· Administrative system: Medware

· Claims processes and procedures

· Chronic diseases list

· Prescribed minimum benefits

· Care plans and cases

· Basic medical terminology

Salary:

R 180k - R 220k ctc per annum (negotiable depending on experience)

Medical aid and provident fund

Performance based bonus