The Medical Pages jobs

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. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities and businesses.

Qualification

• Matric (Essential)
• Tertiary qualification (Advantageous)
• Claims School training (Advantageous)

Experience

• Experience in claims assessing (Essential)
• 1-3 years of experience in the medical aid industry (Essential)
• 2-3 years of Claims processing experience within the medical aid industry (Essential)
• 2-3 years of query management or client service experience (Essential)

Knowledge

• Knowledge of PMB process (Advantageous)
• Good understanding of the MH systems (Advantageous)
• Good written and verbal communication
• Understanding and knowledge of the interpretation and application of CMS, Department of Health,BHF, Private hospitals, etc., (Advantageous)
• Proficiency in computer systems(i.e. E-mail, Word, and Excel) (Essential)

Internal Process

• Identifying risks to the company and escalating accordingly.
• Engage in effective communication and deliver according to service levels.
• Maintaining a consistent service delivery to ensure client retention and satisfaction.
• Respond to queries efficiently within the agreed Service Level Agreement (SLA).
• Providing first-time resolution onqueries.
• Driving and supporting effective team work within the department.
• Engaging in appropriate training interventions to promote own professional development.
• Demonstrate the company's values on a daily basis.
• Recording of all queries and interactions with customers onto all applicable systems.
• Escalate client queries to the relevant department or stakeholder via the applicable channel.
• Collaborate with relevant departments to ensure the resolution of queries.
• Develop and maintain productive and collaborative work relationships with peers and stakeholders.
• Positively influence and participate in change initiatives.

Client

• Offer authoritative expertise to clients and stakeholders regarding claims matters.
• Foster and maintain strong relationships with clients and internal and external stakeholders.
• Fulfill service level agreements with clients and stakeholders to effectively manage client expectations.
• Make recommendations for enhancing client service and ensuring fair treatment within the scope of responsibility.
• Actively participate in creating aculture that values relationships,encourages feedback, and delivers exceptional client service.

People

• Develop and maintain productive and collaborative relationships with peers and stakeholders.
• Actively contribute to and support change initiatives within the organization.
• Continuously enhance professional expertise in terms of industry knowledge, legislation,and best practices.
• Contribute to continuous innovation by sharing and implementing new ideas.
• Take ownership of career development and drive personal growth.

Finance

• Identify opportunities to improve cost-effectiveness and operational efficiency.
• Manage financial and other resources under your control with diligence and responsibility.
• Provide input into risk identification processes and communicate recommendations in the appropriate forums.
• Continuously develop own expertise in terms of professional,industry, Scheme and legislation knowledge
• Identify opportunities to enhance cost-effectiveness and increase operational efficiency