Quality Consultant: Claims Management - Centurion, South Africa - PPS Recruitment

PPS Recruitment

Verified Company

Centurion, South Africa

1 week ago

Posted by:

Thabo Mthembu

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Job Advert Summary:

Minimum Requirements:

A minimum of Grade 1
A minimum of 6 years' experience in medical scheme claims administration
5 years' knowledge of the medical aid industry, regulations, RPL, ISO and other related legislation
1 year knowledge of coding systems (RPL, ICD)
1 year experience in Keyhealth and Profmed Scheme Rules
2 years' MIP and MSO system knowledge
Good communication, administration skills including record keeping and the ability to work under pressure
Must be a strong team player
Computer literacy (Basic Excel Skills)
Quality orientated
Attention to detail
Proficient in MS Office

Duties and Responsibilities:

Carry out spot checks on both paper and EDI claims processes by consultants daily.
Reconcile member or provider claims received
Evaluate and assess the quality of the consultants' work using the Administration system, documented processes and published reports in order to identify and address problems or shortcomings within the group.
Generate ad hoc reports on Jasper
Quality control to ensure error rate is minimized
Calculate individual error rates, compile and maintain an excel spreadsheet on a daily basis using information of individual error rates in order to send updated statistics to the Claims Coach
Provide feedback to coaches on possible areas of growth per consultant
Ensure accurate and timeous processing of medical claims received from Members and Service Providers when needed.
Assisting with all ad hoc requests when required
Behave in alignment with the PPSHA values.
Analyse data (errors) to identify areas for improvement in the Administration system