Subscribe to Job Alert
Join our happy subscribers
Never pay for any CBT, test or assessment as part of any recruitment process. When in doubt, contact us
Momentum Metropolitan Holdings, formerly MMI Holdings, is a South African-based financial services group was established on 1 Dec 2010, through the merger of Metropolitan and Momentum. We are specialists in long and short-term insurance, asset management, savings, investments, healthcare administration, health risk management, employee benefits and reward...
Read more about this company
INTRODUCTION
Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.
ROLE PURPOSE
Manually intervene on claims flagged into auditing and apply clinical verification and preparation of medical quotations.
WHAT YOU'RE GOING TO DO
Ensure that claims are audited as per instructions and are carried out correctly and in line with assessing guidelines
Refer red flags to medical advisor for clinical input
Ensure adherence to organisational best practice and legislative requirements
Identify potential new rules that could be implemented as a cost saving measure
Identify risks to the company while doctor profiling and escalate accordingly
Maintain a consistent service delivery to ensure client retention and satisfaction by working within service level agreements
Maintain broad product knowledge in order to effectively and accurately respond to customer queries.
Ensure clear communication to all parties involved in an investigation in terms of outcomes and process
Support effective teamwork
Engage with appropriate training interventions to promote own professional development
Actively live the Company values
Interact with internal and external customers in an effective and efficient manner
Basic knowledge and application of business administrative activities
Ability to prepare written quotations based on assessing, legislative and scheme rule knowledge
Accepts accountability for own mistakes and ensures corrective action is taken
WHAT YOU'LL NEED:
Matric/Grade 12
3-5 years of experience in claims assessing on all medical disciplines is essential
1 year experience in the auditing of all medical aid claims is essential
Thorough knowledge of the Oracle operating system
Computer literacy (Email, Word and Excel) is an advantage
The ability to interpret and apply claim and scheme rules correctly is essential
Knowledge of the NHRPL(National Health Reference Price List)and SAMA tariffs is preferred
WHAT COMPETENCIES YOU'LL REQUIRE
Resolves client problems within his or her job scope.
Delivers within the parameters of Service Level Agreements
Is engaged and demonstrates energy in the execution of tasks
Accepts accountability for own mistakes and ensures corrective action is taken
Completes assignments and tasks according to the predefined guidelines
Improves ineffective work practices when required.
Works cooperatively with others.
Recognises own strengths and limitations.
Engages with others and tries to understand individual differences
ADDITIONAL INFORMATION
Shortlisted candidates will be subjected to the following statutory checks:
• Credit
• Criminal
• References
• Qualifications
Build your CV for free. Download in different templates.
Join our happy subscribers