Medical Claims Validator

SUMMARY:
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POSITION INFO:

Together with our client, a leading claims administrator in Pretoria East, we are recruiting for a Medical Claims Validator to join their team. The ideal candidate needs to have minimum 2 years Medical claims related experience and must have matric/grade 12.

Duties and Responsibilities:

Operational:

• Assess COID claim information
• Assess billing on account per item in terms of COID Gazette
• Assess accounts against payment history received from COID
• Practice management of assigned practices
• Effective communication with assigned practices
• Assisting with client support and operational queries on accounts submitted;
• Provide medical advice and/or direction on claims to clients;
• Following up on outstanding information required from clients and employers for processing of medical claims and invoices;
• Resolve enquiries from clients related to the COID Act and medical treatment of patients;
• Contribute to daily operations; and
• Endure that all procedures are followed and that all production goals are met.
• Adhere to production deadlines.
• Assist to accomplish set revenue targets.
• Assist with training of newly appointed staff in the same division.
• Updating DS system with the relevant claim numbers from the Compensation Fund system.
• Upload of medical reports in the prescribed format on the Compensation Fund system.
• Assist in other areas of the department where required

Ad-hoc:

• As a team member add value and contribute to the company;
• Assist to accomplish set revenue targets;
• Show willingness to adapt to industry and company changes;
• Show positive attitude towards your job, colleagues and clients;
• Be willing to share knowledge, do training and comply with set company policies; and
• Assist in other areas of the department where required

Minimum Qualifications and Education Requirements:

• Matric / Grade 12;
• Tertiary qualification will be beneficial;
• Experience in Client and Funder Communication essential; and
• Medical claims related experience will be essential.

Preferred Skills, Competencies & Personal Traits:

• Computer literate in MS Office (Microsoft Excel, Word, and Outlook)
• Articulate with strong communication skills (oral and written);
• CompEasy / Exempt funders / Medical claims online systems will be beneficial;
• Exhibits an inquisitive nature and a proactive, problem-solving attitude;
• Ability to adapt and learn new skills;
• Ability to multitask; and
• Cope well under pressure.

Remuneration

• Market related - depending on experience

Only candidates who meet all the requirements stipulated in this advert will be considered. If you don’t receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

To apply please send your CV and supporting documents to with REF: Validator