Claims Administrator (6 Month Fixed Term Contract)
Listing reference: click_018634
Listing status: Online
Apply by: 27 November 2024
Position summary
Job category: Retail Operations
Location: Roodepoort
Contract: Fixed Term Contract
Remuneration: Market Related
EE position: Yes
Introduction
To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections through corrective action.
Job Objectives:
- Resolve medical aid rejection queries with members where medical aid has no impact (e.g., benefit exceeded).
- Resolve medical aid rejection queries with medical schemes (e.g., medication authorization).
- Provide members with status updates regarding rejections and their resolutions.
- Resubmit all rejections within the target set per medical aid (i.e., between 40 and 60 queries per day to medical aid three days prior to the due date of delivery).
- Resolve queries received from patients within a two-hour turnaround time (e.g., extended supplies due to members going overseas).
Knowledge:
- IT applications areas and delivery channels (Marconi, Phoenix, and Exsol).
- Medical Aid Formularies (6 months).
- Product knowledge (1 year).
- Pharmacy Council Legislation (1 year).
Skills:
- Analysing.
- Deciding and Initiating Action.
- Adhering to Principles and Values.
- Persuading and Influencing.
- Working with People.
- Adapting and Responding to Change.
- Achieving Personal Work Goals and Objectives.
- Applying Expertise and Technology.
- Following Instructions and Procedures.
- Delivering Results and Meeting Customer Expectations.
Education:
National Senior Certificate
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