Job Details

Company in managed healthcare is seeking a Tariff and Rules Master (Claims Department) to ensure that the tariffs and rules are loaded correctly on the administration system, and to maintain this function with regards to updates and changes. The Tariff and Rules Master assist the Claims Manager to determine the strategy, structure, policies and procedures for the Claims Department.

Duties:

The position requires that the Tariff and Rules Master ensure the accurate payment of claims by focusing on the rules and tariffs on the administration system
The Tariff and Rules Master needs to assist staff with related queries
The Tariff and Rules Master works cross functionally with other business units and have to build relationships between departments


Candidate Requirements:

Grade 12 (minimum)

Diploma/ Certificate

Medical aid industry experience of minimum 5 - 8 years

Personnel coaching experience

Specialized medical aid claims knowledge

Experience required:

Claims experience
Leadership/ management
Experience in the Medical aid industry
NRPL tariffs structure experience


Communication to understand:

Scheme benefits and rules
Medical Schemes Act
Prescribed Minimum benefits
Communication from the Council of Medical Schemes and BHF