Claims Assessor

SUMMARY:
Claims Assessor
Nelspruit
R7 700 per month with 100% Subsidised Medical aid

POSITION INFO:
The objective of the claims assessor position is to help achieve, by means of effective actions and assistance to Manager, Service Providers and Members, objectives in respect of effective productivity and client services.


Minimum requirements:

PRIMARY DUTIES

• Assessing of claims
  • Processing claims, reflect changes in benefits/limit available.
  • Target of 300 lines per day/ 6 300 lines per month to be assessed on Novus.
• Customer Care
  • Attend to Service provider queries (written/verbal), correspondence with external as well as internal stakeholders.
• Ad hoc assignments
  • Perform any additional duties from management.
• POPIA
  • Maintain the highest level of confidentiality and security when handling sensitive personal/medical information in accordance with SA Policies and POPI Act.
  • Handle personal and medical information securely. All information coming in should only be shared with authorized personnel and used for legitimate business purposes.
  • Cooperate fully during compliance audits to ensure adherence to the POPI Act, especially regarding the processing of health-related information.

• Grade 12 or equivalent
• Mathematics Grade 12
• Computer literate
• Any experience in the medical aid or insurance industry is an advantage
• Experience with ICD10 codes preferential or any medical background
• Experience capturing a high volume of data with a high accuracy level
• Debtors experience
• Strong attention to detail
• Must perform independently
• Must possess effective organizing and coordinating skills
• Treat sensitive information confidential