CLAIMS ASSESSOR 358 views

We are looking for a senior registered nurse or registered general nurse. The incumbent will be responsible for adjudicating and processing claims in an effective and efficient manner within the prescribed guidelines set out.

Duties And Responsibilities

• Verifying, validating, adjudicating and batching of claims.

• Initiating recovery process on identified fraudulent claims.

• Checking for possible fraudulent claims from existing claims set.

• Reversing and reprocessing claims emanating from queries.

• Verifying and Adjudicating claims captured for correctness and compliance.

• Reviewing and managing claims in line with targets, processes and within agreed timelines.

• Adjudicating claims manually flagged in the system at various levels.

• Attending to enquiries on benefits and products to members, prospective client and service provider.

• Providing customers with accurate product and service information in an efficient manner.

• Dealing with all customers in a professional and empathetic manner.

• Communicating the claims process to both employer and employees as set out in the claim’s management process

Qualifications And Experience

• Diploma in Nursing.

• 3 years’ experience in a similar or related environment.

• Knowledge of business policies, processes and procedures, legal compliance and claims environment.

• Ability to work in a team environment and supervise a small team.

• Ability to work under pressure.

• Advanced Excel Skills.

• High standard of accuracy with attention to detail.