Local Medical Firm
DUE: 15 NOV 2023
Job description:
A leading medical insurance firm is looking for suitably qualified individuals to fill in the position of CLAIMS ASSESSOR that have arisen within the organization
Responsibilities:
Screening and processing of claims for members adhering to turn-around times
Pre-assesses claims received to ensure compliance with the normal schedule of benefits, whether the dates of treatment fall within the cover period etc
Keeping record of all claims received, processed and rejected; reprocesses adjusted claims where necessary
Attending to members’ and providers’ on service queries as well as advising members on rules and benefits; liaises with other departments for appropriate action
Reports system errors picked up during assessing to the supervisor for logging with IT department.
Calculates awards and shortfalls on pro forma invoices, informs members on affordable options.
Applies for appeals on ex-gratia and waivers
Qualifications:
Degree and diploma in Nursing
Degree or diploma in Risk and insurance an added advantage
Knowledgeable with claims processing systems e.g. Health Information Management System HMS.
Experienced in claims Authorization processes
Experience in the medical aid sector an added advantage
Good interpersonal relationships
Fluent in English, Shona and Ndebele
TO APPLY
Applicants to send CVs to kudakwashe.kanombirira@yahoo.com or before 15 November 202