Medical Claims Validator

Together with our client, a leading claims administrator in Pretoria East, we are recruiting for a Medical Claims Validator to join their team. The ideal candidate needs to have minimum 2 years Medical claims related experience and must have matric / grade 12.

Duties and Responsibilities :

Operational :

• Assess COID claim information
• Assess billing on account per item in terms of COID Gazette
• Assess accounts against payment history received from COID
• Practice management of assigned practices
• Effective communication with assigned practices
• Assisting with client support and operational queries on accounts submitted;
• Provide medical advice and / or direction on claims to clients;
• Following up on outstanding information required from clients and employers for processing of medical claims and invoices;
• Resolve enquiries from clients related to the COID Act and medical treatment of patients;
• Contribute to daily operations; and
• Endure that all procedures are followed and that all production goals are met.
• Adhere to production deadlines.
• Assist to accomplish set revenue targets.
• Assist with training of newly appointed staff in the same division.
• Updating DS system with the relevant claim numbers from the Compensation Fund system.
• Upload of medical reports in the prescribed format on the Compensation Fund system.
• Assist in other areas of the department where required

Ad-hoc :

Minimum Qualifications and Education Requirements :

Preferred Skills, Competencies & Personal Traits :

Remuneration

Only candidates who meet all the requirements stipulated in this advert will be considered. If you don’t receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.