Claims Assessor

Job ID: 23276

MMI Holdings Limited (MMI) is a South African based financial services group listed on the South African stock exchange, the JSE. The group operates in the market through multiple client-facing brands including insurance and investment brands Metropolitan and Momentum, South Africa’s number one cell captive insurer Guardrisk and wellness & rewards programme Multiply. MMI operates in 14 countries, 12 in the African continent, United Kingdom and India through a direct presence, strategic partnerships and joint ventures.

MMI’s purpose is to enhance the lifetime Financial Wellness of people, their communities and their businesses. Financial Wellness is a continuous process of planning and management for individuals, households and businesses, with the aim of affording expenses and achieving goals over one’s lifetime. Our promise to our clients is to be their Financial Wellness partner over this life-long journey, using our expertise and solutions to help them develop and reach their goals. Visit us at www.mmiholdings.co.za

INTRODUCTION

MMI Health, an entity of MMI Holdings Limited (MMI), 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. 

ROLE PURPOSE

Assess and process medical aid claims as per Claims procedures.

WHAT YOU’RE GOING TO DO

• Accurately capture and process all incoming medical aid claims (paper, EDI, real time,
workflow) within agreed timeframes
• Processing of claims according to predetermined standards and business processes
• Ensure that claims validation is performed in accordance with legislation and scheme rules
• Quality control to ensure error rate is minimised

WHAT YOU’LL NEED:

• Matric
• Computer literate
• Comprehensive knowledge of all aspects of medical aid assessing
• Minimum of 2 – 3 years experience as a claims assessor preferable
• Industry knowledge (BHF; Tariff Guide; SAMA, ICD10 codes)

WHAT COMPETENCIES YOU’LL REQUIRE

• Attention to detail and accuracy
• Problem solving ability
• Ability to function effectively within a team
• Ability to work under pressure

• Consistently works to meet expectations
• Resolves client problems within his or her job scope.
• Is engaged and demonstrates energy in the execution of tasks
• Accepts accountability for own mistakes and ensures corrective action is taken

ADDITIONAL INFORMATION

Shortlisted candidates will be subjected to the following statutory checks:

  • References
  • ITC
  • Qualification
  • Criminal

All positions will be filled in accordance with our Employment Equity plan.
We also encourage people with disabilities to apply.

APPLY HERE

Updated: — 11:20 am
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