Claims Administrator - Johannesburg, South Africa - Clicks Group Limited

Clicks Group Limited
Clicks Group Limited
Verified Company
Johannesburg, South Africa

2 weeks ago

Thabo Mthembu

Posted by:

Thabo Mthembu

beBee Recruiter
Description

Advert reference:
click_012554


Advert status:
Online

-
Position Summary:


Industry:
Call Centre Industry


Job category:
Retail Operations


Location:
Gauteng


Contract:
Permanent


Remuneration:
Market Related


EE position:
Yes


Brand:
Clicks Group


Introduction:

To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections by corrective action


Job description:


Job Objectives:


  • To resolve medical aid rejection queries with member where medical aid has no impact e.g. benefit exceeded
  • To resolve medical aid rejection queries with medical scheme e.g. medication authorization
  • To provide member with status update regarding rejection and resolution thereof.
  • To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical aid three days prior to due date of delivery
  • To resolve queries received from patients within a two hour turnaround time e.g. extended supplies due to member going oversees

Knowledge:


  • Current IT technology (6 months)
  • Medical Aid Formularies (6 months)
  • Product knowledge (1 year)
  • Pharmacy Council Legislation (1 year)

Skills:


  • Communication skills
  • Problem solving skills

Competencies:


Essential:

  • Analysing
  • Deciding and Initiating Action
  • Adhering to Principles and Values
  • Persuading and Influencing
  • Working with People
  • Adapting and Responding to Change
  • Achieving Personal Work Goals and Objectives
  • Following Instructions and Procedures
  • Delivering Results and Meeting Customer Expectations

Minimum requirements:


Education:


Essential
National Senior Certificate
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