Claims Assessor Job at Metropolitan in Cape Town

Job Title: Claims Assessor

Cape Town

    Introduction

    Internal applications are invited from suitably qualified persons to fill the following vacancies in the Private Sector Claims Processing Department. The overall responsibilities of the candidate will, amongst other duties be the assessing of claims and attending to investigations and preparations for the Bankmed Medical Scheme.

    The Incumbent will be responsible for:

    Capturing and processing of all incoming paper image and Electronic Data Image claims within service level agreement

    Ensuring that all claims are paid according to the Rules of the Medical Schemes Act and Scheme Rules

    Achieving predetermined standards and quality levels

    Repricing of claims and or preparation of international claims where applicable

    Quality control to ensure error rate is minimised

    Escalating of queries where necessary for further investigation

    Filing of Documentation when needed

    Keeping abreast with industry changes and knowledge as well as successfully
    completing all Quarterly assessments

    The applicant should meet these requirements:

    Matric or grade 12 equivalent

    1 years Claims assessing experience (EDI, Paper image or any other) advantageous

    1 years medical scheme experience with at least 2 years in medical scheme claims assessing advantageous

    Computer literacy (especially Email, Word & Excel)

    Competencies Required

    Strong medical aid background and knowledge

    Be familiar with the application of Scheme rates and tariffs

    Modifiers and Rules that apply to assessing of claims

    Have some knowledge of diagnosis on the accounts

    Ability to interpret and apply scheme rules correctly

    Good interpersonal skills with strong attention to detail and accuracy

    Ability to solve problems and motivate ideas

    Ability to interact at all levels

    Customer service orientation and application of member advocacy principal

    Job and technical knowledge and competence

    Additional Information

    Shortlisted candidates will be subjected to the following statutory checks:

    ITC
    Criminal
    References
    Qualification

    We reserve the right to fill this position

    Should you not receive any feedback within 2 weeks, please consider your application as unsuccessful

    Disclaimer

    Only on-line applications submitted via our careers page will be considered.


    Internal Team Members must inform their manager of their application. Your manager must be aware of and support your application.

How to Apply:

http://careers.metropolitan.co.za/psp/Applicant/EMPLOYEE/HRMS/c/HRS_HRAM.HRS_CE.GBL

Deadline: 04/03/2014