Claims Specialist X5

at  Health Solutions

INTRODUCTION

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities

REQUIREMENTS

• Matric
• Tertiary qualification (advantageous)
• Claims School training (advantageous)
• Computer Literacy (i.e. E-mail, Word, and Excel) is essential.
• Experience in claims assessing is essential.
• Knowledge of PMB process (advantageous)
• 1-3 years of experience in the medical aid industry is essential
• 2-3 years of Claims processing experience within the medical aid industry is essential.
• 2- 3 years of query management or client service experience is essential
• Good understanding of the MH systems would be advantageous.
• Good written and verbal communication
• Understanding and knowledge of the interpretation and application of CMS, Department of Health, BHF, Private hospitals, etc., (advantageous).

ROLE PURPOSE

To provide an effective and efficient service to clients by receiving, evaluating, and responding to enquiries timeously.

DUTIES & RESPONSIBILITIES

• Identifying risks to the company and escalating accordingly.
• Engage in effective communication and delivery according to service levels
• Maintaining a consistent service delivery to ensure client retention and satisfaction.
• Respond to queries efficiently within the agreed Service Level Agreement (SLA).
• Providing first-time resolution on queries
• Driving and supporting effective teamwork within the department
• Engaging in appropriate training interventions to promote own professional development.
• Demonstrate the company’s values on a daily basis.
• Recording of all queries and interactions with customers onto all applicable systems.
• Escalate client queries to the relevant department or stakeholder via the applicable channel.
• Collaborate with relevant departments to ensure the resolution of queries
• Develop and maintain productive and collaborative work relationships with peers and stakeholders
• Positively influence and participate in change initiatives