Medical Insurance Firm
DUE: 07 NOV 2023
Position:CLAIMS ASSESSOR X 2
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
- 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
- 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
Applicants to send CVs to firstname.lastname@example.org or on whatsapp 0773 773 385 before 7 November 2023