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
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
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Degree or diploma in Risk and insurance an added advantage
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Knowledgeable with claims processing systems e.g. Health Information Management System HMS.
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Experienced in claims Authorization processes
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Experience in the medical aid sector an added advantage
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Good interpersonal relationships
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Fluent in English, Shona and Ndebele
TO APPLY
Applicants to send CVs to kudakwashe.kanombirira@yahoo.com or on whatsapp 0773 773 385 before 7 November 2023