Claims Assessor at Momentum Metropolitan Holdings Limited

Role Purpose    

•  Assess and process medical aid claims as per Claims procedures.

Requirements    

• Matric
• Computer literate.
• Comprehensive knowledge of all aspects of medical aid assessing is essential.
• Working on the Oracle platform is an advantage.
• A minimum of 2 - 3 years' experience as a claims assessor is an advantage.
• Industry knowledge (BHF; Tariff Guide; SAMA, ICD10 codes) is an advantage

Duties & Responsibilities    

• Accurately capture and process all incoming medical aid claims (paper, EDI, real time, workflow)with in agreed time frames.
• Able to assist cross functionally in the claims department.
• Processing of claims according to predetermined standards and business processes on the Oracle platform.
• Ensure that claims validation is performed in accordance with legislation and scheme rules.
• Quality control to ensure error rate is minimised.
• Work on KRIS reports/departmental reports.
• Pay claims correctly the first time and on time to members or service providers there by reducing repeat queries and escalations.

Competencies    

• Attention to detail and accuracy
• Problem solving ability
• Ability to function effectively within a team.
• Ability to work under pressure.
• Consistently works to meet expectations.
• Resolves client problems within his or her job scope.
• Is engaged and demonstrates energy in the execution of tasks.
• Accepts accountability for own mistakes and ensures corrective action is taken.

Deadline:14th October,2025