Job vacancy Temporary Claims Consultant

The Claims Consultant will be responsible for managing the processing of medical claims and ensuring that payments are made in a timely and accurate manner. The role involves reviewing and assessing medical claims, communicating with both healthcare providers and patients, and ensuring that all documentation is compliant with regulatory standards. The successful candidate must be highly organised, have excellent attention to detail, and possess the ability to work in a fast-paced environment. Excellent communication and interpersonal skills are essential, as well as a good understanding of medical terminology and ICD coding.

• Reconcile member or provider claims received.
• Ensure accurate and timeous processing of medical claims received from Members and Service Providers.

• Check the technical aspects of the claim – Inclusive of potential non-disclosure, and exclusions.
• Review all medical information on file, analyze and synopsize information at hand.
• Determine and record additional required information.
• Correspondence to clients with respect to claims outcomes and requirements for future claims in order to manage claims.
• Keeping accurate records of all claims assessed in accordance with departmental procedures.
• Deal with first line queries by members and providers telephonically and via e-mail.
• Participation in projects to improve departmental service-owning your role in the project and completing tasks as required by providing input.

The successful candidate should posess the following:

• Proficient in the assessment and management of medical claims
• Proficient in medical coding 
• Excellent computer skills and a strong ability to learn quickly
• Excellent communication skills, both written and spoken
• Team work
• Strong interpersonal skills and an ability to work with people at all levels.
• Degree in Health Information Systems/Informatics or equivalent
• Previous experience in a Medical Aid environment is advantageous