Talent Pool: Technical Specialist - Claims MMH251128-18

Role Purpose

The role is responsible for the technical support, maintenance, enhancement, integrity and governance of claims backend functionality that support accurate claims adjudication.

Requirements

Qualifications

• Matric / Grade 12 - Essential
• Relevant certification or training in medical aid administration, healthcare funding, claims processing, data management or systems support. - Essential

Knowledge

• Solid understanding of the medical aid industry's processes, regulations, and dynamics.
• Claims processes, procedures and operating systems
• Claims legislation and Scheme rules
• Claims processing methods and techniques
• Training techniques and methods
• Deep understanding of the medical aid industry, specifically claims procedures, best practices and legislation.
• Familiarity with logging of IT help-desk calls
• Familiar with audit ...