Query Resolution Officer

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 organisations care for and reward their employees and members.

Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page.

Role Purpose Review control reports to identify training needs within the team and maintain relationships with internal and external auditors and other business units.

Requirements

• Matric / Grade 12.
• 3 – 4 years claims assessing experience preferred.
• Excellent literacy, numeracy, 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 adventageous.
• 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.
• Appropriate 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 accountability for own mistakes and ensures corrective action is taken.