Query Resolution Officer (12 Months Contract)

Introduction Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organizations’ care for and reward their employees and members.

Role Purpose To ensure a professional and consistent customer service delivery through the resolution of escalated queries.

Requirements

• Matric / Grade 12

• 3 - 4 Years claims assessing experience preferred

• Excellent numeracy, literacy, and communication skills

• Multi-discipline claims knowledge

• Good knowledge of PMB at industry level as well as in house PMB processes

• Good knowledge of modifiers and their application

• Proven experience in the assessing of medical aid claims (paper and/ or EDI) will be advantageous

• Computer literacy (especially email, word and excel)

• Passionate about driving a high performance culture

• The ability to interpret and apply scheme rules correctly

• Knowledge of the NHRPL-National Health Reference Price List (Previously known as BHF) and SAMA tariffs

Duties & Responsibilities

• Accurate and timeous resolution of claims queries

• Correctly reverse and reprocess the related claim

• Ensuring that no duplicate claims are paid during the process

• Appropiate pay code is applied

• Assisting other departments with claims related queries

• Liaising with other departments to resolve queries

• Recording all queries and interactions with customers on to the workflow system

• High quality and service output

Competencies

• 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 accountabilty for own mistakes and ensures corrective action is taken