Claims Assessor Intern at Netcare

 OPERATIONAL EXCELLENCE

Claim Assessment

• Assessing of all claims for all disciplines and products
• Identify systems / processes enhancement and implementation
• Management of the Service Level Agreements with brokers, Sales and Operations
• Vendor documentation manage and administer
• Assist in telephone queries
• Give feedback to vendors on queries
• Use system for updates
• Interact with NOH team to assist with issues and data input
• Keep claims administrator updated with escalations
• Requires excellent communication skills – verbal and written
• Reports trends or issues to Business Centre Team leader
• Ensure excellent knowledge of all NetcarePlus products and services                                                            

GROWING WITH PASSIONATE PEOPLE

Teamwork

• Actively participate as a member of a team to achieve goals.

Personal and professional development

• Keep up to date with Netcare’s evolving policies and procedures.
• Active involvement in own professional development to maintain a satisfactory level of skill and knowledge.
• Ensure professional conduct at all times.

Build and Maintain stakeholder relationships

• Work effectively and co-operatively with others to establish and maintain good working relationships that are mutually beneficial.
• Create and maintain a positive environment where the differences of others are recognized, understood, and valued, so that all can reach their full potential and maximize their contributions.
• Develop collaborative relationships to help accomplish work goal.

EDUCATION

Essential

• Relevant Finance qualification.

WORK EXPERIENCE

Essential

• Minimum of 3 years successful claims assessing experience within the Health Care Industry.

KNOWLEDGE

Essential

• Claim assessing knowledge.
• Conversant with ICD 10 and CPT coding.
• Conversant with Modifiers and NHRPL.
• Conversant with Scheme Benefits.
• Accuracy, and Strong numerical ability.