Rand Water Vacancy Re-Advertisement, Medical Scheme Claims Assessor X3 Posts

Rand Water is looking for three (3) Medical Scheme Claims Assessors to manage the daily operational requirements of the Rand Water Medical Scheme for claims assessing (auditing) and monitoring requirements for clinical IT administration system enhancements; aligned with Scheme rules and clinical protocols.

Rand Water Vacancy Re-Advertisement, Medical Scheme Claims Assessor X3 Posts

Those with a BCur Nursing degree or a Diploma in General Nursing with Midwifery, Psychiatry and Community Health/ Diploma in General Nursing and a Diploma in Midwifery/ Diploma in General Nursing and a Diploma in ICU/ Theatre and/or Trauma are encouraged to apply.

Minimum Requirements

• Grade 12

• Degree in General Nursing or Diploma in General Nursing and Midwifery/ Diploma in General Nursing and Diploma in Midwifery/ Diploma in General Nursing and Diploma in Midwifery (Diploma in ICU/Theatre and/or Trauma would be a plus)

• 2 – 3 years experience in a private hospital setting

• Working for a medical scheme (closed or open) for 2 – 3 years

• Claim assessment experience with ICD10 codes, tariff codes, modifiers, and critical clinical protocols.

Primary Duties

• Using clinical protocols and scheme rules, process different types of medical claims

• Deliver excellent customer service (electronics, walk-ins, telephony, roadshows)

• Improving operational efficiency through creative and innovative ideas as per scheme business processes

• Tracking requests for system enhancements to the DSP, identifying gaps in the IT Admin System

• Compile monthly operational reports and give them to the Medical Scheme Supervisor

• Strong knowledge of ICD10 codes, tariff codes, modifiers, and critical clinical protocols

Closing Date:01 June 2023