Claims Specialist - Centurion at Momentum Metropolitan Holdings Limited

Requirements

• Grade 12 with at least 50% achieved for Mathematics or 60% Mathematical Literacy.
• 2- 4 years claims assessing related experience within a medical aid administration environment.
• Computer Literacy (i.e. E-mail, Word and Excel).
• Ability to interpret and apply scheme rules correctly.
• Thorough knowledge of the MH claims operating system.
• Experience in electronic and paper claims assessing.

Duties & Responsibilities

• Assessing both EDI and paper claims.
• Liaising with external business partners.
• Providing quality written feedback to claims queries.
• E-mail investigations, escalated complaints, and Client service queries.
• Ensure all correspondence is archived and dealt with timeously.
• Provider/member investigation.
• Provider/membership profiling and trend analysis.
• In-depth understanding of various claims processing methods.

Competencies

• Analysis
• Problem Solving
• Attention to detail
• Effective Communication Skills (verbal and written)
• Ability to work in a fast pace and pressurised environment
• Results orientated