Claims Assessor

Position Purpose: To ensure that claim lines that require manual intervention are released efficiently and timeously, as per agreed TAT by applying assessing and Scheme rules.

Experience: A minimum of 2-3 years’ experience in a Managed Healthcare will be advantageous.

Qualifications: Tertiary qualification in related field.

KEY PERFORMANCE AREAS

• Conduct accurate and effective intervention/reconciliation of administration on all allocated claims
• Accurately and efficiently process allocated claims according to the defined process and within Service Level Agreement
• Continuously apply relevant rules
• Follow documented Assessing policies and procedures pertaining to manual intervention and reconciliation of claims
• Rectify incorrect information on claims and elevate where required
• Reconcile claims where required and communicate outcome
• Ensure correct payments to ve...