Position: Medical Claims Validator
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.
- 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 company’s core operations.
- 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.
- COIDA knowledge;
- COIDA medical tariff knowledge;