What the job is

This is a full-time position for a Claims Assessor specializing in Gap Cover at Moladira Skills, based in Roodepoort, Gauteng. The role involves processing and assessing healthcare claims to ensure accuracy and compliance with company policies and regulations.

What you will do

You will accurately capture and process paper Gap claims into the iMed system. You will review and assess claims according to scheme rules, coding principles, and managed care policies. You will verify documentation, communicate with clients and stakeholders to gather necessary information, and ensure correct payments are made to vendors or members. You will also resolve operational issues, maintain detailed records, and assist with training and knowledge-sharing within the team. Additionally, you will handle call center queries and perform ad-hoc duties as required.

What you need

You need at least 3 years of experience in the healthcare industry, short-term insurance, credit data capturing, and claims processing. A Matric certificate and RE5 qualification are required. You should have strong problem-solving, communication, and numerical skills, as well as proficiency in Microsoft Office Suite and relevant systems. Knowledge of relevant legislation, processes, and scheme rules is essential.

What you will get

The salary for this permanent position is R23,000 per annum. You will work in a structured environment with opportunities for professional development, coaching, and mentoring.