Dental Claims Administration at Metropolitan

Role Purpose    

• To pre-assess, capture, and clinically assess claims.

Requirements    

• Grade 12/Matric.
• Computer literate (email, MS Word and Exel).
• Comprehensive knowledge of all aspects of medical aid assessing
• Minimum of 2 - 3 years' experience as a claims assessor preferable
• Industry knowledge (NHRPL (previously known as BHF); SAMA Tariffs, ICD10 codes)
• The ability to interpret and apply scheme rules correctly

Duties & Responsibilities    

• Accurately capture and process all incoming Dental medical aid claims (paper, EDI, real time, workflow) within agreed timeframes.
• Processing of claims according to predetermined standards and business processes.
• Ensure that claims validation is performed in accordance with legislation and scheme rules.
• Quality control to ensure error rate is minimised.

Competencies    

• Attention to detail and accuracy
• Problem-solving ability
• Ability to function effectively within a team
• Ability to work under pressure