Re-advertisement: Medical Scheme Claims Assessor - Glenvista, South Africa - Rand Water

Rand Water

Verified Company

Glenvista, South Africa

1 week ago

Posted by:

Thabo Mthembu

beBee Recruiter

Description

Job Advert Summary:

Rand Water is looking for a Medical Scheme Claims Assessor to manage daily operational requirements of the Rand Water Medical Scheme for claims assessing (auditing) and monitoring requirements for clinical IT administration system enhancements; align with Scheme rules and clinical protocols.

Minimum Requirements:

Grade 1
B.Cur Nursing degree of Diploma in General Nursing with Midwifery, Psychiatry and Community Health/Diploma in General Nursing or Diploma in ICU/Theathre and/or Trauma
23 years' experience in a private hosptial setting
23 years' experience working for a Medical Scheme (closed or open Scheme)
Experience in claims assessing
Computer literacy

Primary Duties:

Manage and monitor claims administration process
Provide excellent quality customer service to clients (electronically, walk in, telephonically and on roadshows)
Updating policies and procedures through creative and innovative ideas suing available resources of the department to improve operational inefficiencies
Identifying gaps, logging requests for system enhancement to the DSP
Compile monthly operational reports and provide to the Medical Scheme Manager

Knowledge: