Claims Administrator (6 Month Fixed Term Contract)

Claims Administrator (6 Month Fixed Term Contract)Listing reference: click_018634Listing status: OnlineApply by: 27 November 2024Position summaryJob category: Retail OperationsLocation: RoodepoortContract: Fixed Term ContractRemuneration: Market RelatedEE position: YesIntroductionTo 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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