Role Purpose\u00a0\u00a0 \u00a0<\/p>\n
\t\u00a0Assess and process medical aid claims as per Claims procedures.<\/p>\n
Requirements\u00a0\u00a0 \u00a0<\/p>\n
\tMatric
\n\tComputer literate.
\n\tComprehensive knowledge of all aspects of medical aid assessing is essential.
\n\tWorking on the Oracle platform is an advantage.
\n\tA minimum of 2 – 3 years’ experience as a claims assessor is an advantage.
\n\tIndustry knowledge (BHF; Tariff Guide; SAMA, ICD10 codes) is an advantage<\/p>\n
Duties & Responsibilities\u00a0\u00a0 \u00a0<\/p>\n
\tAccurately capture and process all incoming medical aid claims (paper, EDI, real time, workflow)with in agreed time frames.
\n\tAble to assist cross functionally in the claims department.
\n\tProcessing of claims according to predetermined standards and business processes on the Oracle platform.
\n\tEnsure that claims validation is performed in accordance with legislation and scheme rules.
\n\tQuality control to ensure error rate is minimised.
\n\tWork on KRIS reports\/departmental reports.
\n\tPay claims correctly the first time and on time to members or service providers there by reducing repeat queries and escalations.<\/p>\n
Competencies\u00a0\u00a0 \u00a0<\/p>\n
\tAttention to detail and accuracy
\n\tProblem solving ability
\n\tAbility to function effectively within a team.
\n\tAbility to work under pressure.
\n\tConsistently works to meet expectations.
\n\tResolves client problems within his or her job scope.
\n\tIs engaged and demonstrates energy in the execution of tasks.
\n\tAccepts accountability for own mistakes and ensures corrective action is taken.<\/p>\n
Deadline:14th October,2025<\/p>\n
go to method of application \u00bb<\/p>\n
Apply via company website ( ) or<\/p>\n
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