Were looking for A Claims Analyst That will provide timely and accurate processing and adjudication of claims. The role will research, and process claims or related requests for covered members or providers across various products including medical, pharmacy, vision and related healthcare options. Whats the role? You will be responsible for: Review assigned claims or requests from a queue, maintaining a set inventory level. Analyze claims to identify key elements and processing requirements based on diagnosis, provider, medical policy, contract, and/or policy. Perform claim rework, medical reviews, or other assigned projects as needed. Identify and report inaccuracies in adjudication related to system configuration, benefit inconsistencies, and fee schedules. Efficiently and accurately analyse medical claims to determine approval or denial for payment based on plan or client conditions. Resolve pending healthcare claims and prior approval requests. Assist other departments by contributing to projects, providing feedback, conducting research, and resolving inquiries related to claims adjudication. Achieve and exceed key performance indicators for performance, production, and quality. Contribute to personal, team, and organisational development through active participation in knowledge transfer, engagement, and initiatives. Who are you? You know how to communicate clearly and professionally with both internal and external customers. You are have an eye for detail and great time management skills You are able to make informed decisions using available resources and sound judgement. You know how to maintain confidentiality and exercise discretion with sensitive information. You are able to Identify and resolve problems promptly, skillfully gathering and analysing information. You always ensure accuracy and thoroughness in work, consistently monitoring for quality. You know how to adapt to changes in the work environment, manage competing demands, and handle frequent changes, delays, or unexpected events effectively. You are able to act in a manner that builds trust with management, colleagues, and customers. You are willing to work overtime as required, including weekends. Boxes to tick Matric Diploma or equivalent, Bachelors degree preferred or experience in lieu of degree 2 years of medical claims processing including knowledge of medical terminology and working in a production environment. This position entails 3-6 weeks of training which will commence from 2pm-11pm Working Hours after training: 9am - 6pm
