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Claims Assessing Agents

Vacancy Details

Reference No.

NS

Synopsis

A reputable insurance organisation is currently seeking an individual to assume the role of Claims Assessing Agents. The successful incumbent will be responsible for analysing and processing the organisation’s claims in line with the organisation rules and the agreed timelines in respect to Pre-Assessing, Capturing, Interventions and Reversals processes.

Description

  • Apply and implement the departments overall work plans and targets with respect to pre-assessing capturing, interventions and reversals.
  • Review and validate information on all medical claims to ensure that there is no missing or incomplete information.
  • Adhere to relevant laws, regulations, policies and procedures that provide the internal controls in executing the claims process. 
  • Ensure operational alignment to the ISO processes, Standard Operating Procedures and organisation rules, policies and procedures.
  • Ensure that the claims are captured correctly paid against the correct information.
  • Identify gaps in processes, analyses and improve where necessary to increase speed, quality and gain efficiencies within the department.
  • Ensure excellent service levels to all stakeholders, by ensuring that claims are paid timeously and accurately.

Requirements

  • Matric.
  • 3 years’ experience in the Medical aid industry.
  • 3 years claims assessing with reversal and intervention experience.
  • 2 years Medical aid Support Services or Contact Centre experience.

Kindly note, if you have not heard from us within two weeks of your application please consider it unsuccessful.

Position Type

Permanent

Work Level

Mid-Level

Salary

Market Related

Industry

Insurance

Salary Type

Annually

Package

Cost To Company

Affirmative Action

Yes

Geographic Location

Gauteng