Job title: Medical Claims Validator
Job type: Permanent
Emp type: Full-time
Industry: Medical Practice
Expertise: Pharmaceutical
Salary type: Monthly
Salary: ZAR 18,000.00
Location: Pretoria, South Africa
Job published: 2020-02-06
Job ID: 31980

Job Description


Position: Medical Claims Validator

Job Summary

A well-established company with 60 employees specialising in claims administration requires a Medical Claims Validator to assist with the processing and adjudicating of statutory medical claims and provide training and feedback to clients.

Duties and Responsibilities

  • Assess COID claim information
  • Assess billing on account per item in terms of COID Gazette
  • Assess accounts against payment history received from COID
  • Practice management of assigned practices
  • Effective communication with assigned practices
  • Assisting with client support and operational queries on accounts submitted;
  • Provide medical advice and/or direction on claims to clients;
  • Following up on outstanding information required from clients and employers for processing of medical claims and invoices;
  • Resolve enquiries from clients related to the COID Act and medical treatment of patients;
  • Contribute to daily operations; and
  • Endure that all procedures are followed and that all production goals are met.

As a team member add value and contribute to the company:

  • Assist to accomplish set revenue targets;
  • Show willingness to adapt to industry and company changes;
  • Show positive attitude towards your job, colleagues and clients;
  • Be willing to share knowledge, do training and comply with set company policies; and
  • Perform ad hoc tasks in line with the objectives of the Company as and when required by the Company.


Job requirements

  • The candidate must have Matric;
  • The candidate must ensure that they are familiar with and gain full knowledge of the Compensation for Occupational Injuries and Diseases Act (COIDA);
  • The candidate must have experience in the Medical Services claims industry and knowledge of legislation regulating the industry;
  • The candidate must have sufficient medical background to be able to assist with client enquiries and the adjudication of difficult cases where specialist knowledge is required; and
  • The candidate must gain a full understanding of the processes, procedures and systems used in the execution of the companys core operations.



Minimum Requirements

  • Excellent communication (verbal and written), interpersonal and training skills are essential;
  • Time Management skills and experience;
  • Drivers licence and own transport;
  • Computer literate in Microsoft Excel, Word and PowerPoint; and
  • Ability to adapt and learn new skills.


Beneficial knowledge

  • COIDA knowledge;
  • COIDA medical tariff knowledge;