Claims assessor

Position Purpose: To ensure that claim lines that require manual intervention are released efficiently and timeously, as per agreed TAT by applying assessing and Scheme rules.

Experience: A minimum of 2-3 years’ experience in a Managed Healthcare will be advantageous.

Qualifications: Tertiary qualification in related field. KEY PERFORMANCE AREAS Conduct accurate and effective intervention/reconciliation of administration on all allocated claims Accurately and efficiently process allocated claims according to the defined process and within Service Level Agreement Continuously apply relevant rules Follow documented Assessing policies and procedures pertaining to manual intervention and reconciliation of claims Rectify incorrect information on claims and elevate where required Reconcile claims where required and communicate outcome Ensure correct payments to vendor or member Meet delivery objectives through working with other team members within and linked to the depa...