Tasks and responsibilities Submit claims as requested Submit authorization requests Following up on claims to ensure timeous payment is received.
Ensuring proper turnaround times and following the escalation process when needed to ensure that authorisation is received and updated if needed.
Process patient refunds when requested.
Process reversal requests from medical aid payments when requested.
Checking of medical aid remittances to confirm payment and making sure proper capturing is done end of the month.
Making necessary notes on CRM of payments on each file indicating any short payment and following up.
Performs other clerical duties such as filing, photocopying, and collating on request from line manager.
Qualifications and Competency Criteria Essential: Grade 12 pass Job specific in-service training to understand customer needs, and associated products Proficiency will be determined by both theory test results and practical assessments Periodic assessments and performance evaluations to assess ongoing competency Experience Previous experience with medical aid authorizations and claims preferable Proficiency in Microsoft Office suite Pastel 2-3 years of administrative experience in a sales or customer service role, experience in a medical device or healthcare industry preferred Knowledge, Skills and Abilities Fluency in English and Afrikaans Strong written and verbal communication skills Must have own reliable transport Ability to work well under pressure and with large volumes of work Display strong attention to detail Ability to multitask, prioritize and remain organized
