Monday , May 27 2024

Mediclinic Jobs Stellenbosch – Claims Manager

Website Mediclinic

Job Description:

To oversee and supervise the claims department and ensure accurate reimbursement of claims based on agreed medical schemes contracts and ER24 clinical protocols.

Job Responsibilities:

  • Manage the operations of the claims department
  • Manage and maintain claims administration system
  • Manage and mitigate functional risks
  • Compile weekly, month-end and Board reports
  • Build and maintain stakeholder relations
  • Lead and manage the people in the team

Job Requirements:

  • Demonstrate a good understanding of the requirements by medical schemes or EMS providers to obtain authorisations and provide motivations on specific cases
  • Knowledge and application of relevant computer software packages including Microsoft Office Packages (Excel), SAP
  • Understanding and application of all relevant statutory and non-statutory regulations, including but not limited to Council of Medical Aid, HPCSA, PMB, etc.
  • Identification of administrative inefficiencies and the ability to implement improved processes
  • Demonstrate a solid understanding of the Funder Relations environment, with specific reference to the rules and regulations regarding funder contracts, and the application thereof
  • Demonstrates competence on the ER24 Claims System (SAP) and the application thereof
  • Understanding and correct application of claims governance and risk management
  • Knowledge and application of all claims principles, processes, policies and procedures
  • Demonstrates competence in the appropriate application of clinical codes (ICD 10) and finalisation thereof

Qualification & Experience:

  • 2 years management/supervisory experience
  • 5 – 10 years experience in the private healthcare industry;2 -3 years experience in a medical claims environment
  • Good working knowledge of the intricacies of the private healthcare industry
  • Bachelor’s degree or diploma with relevant private healthcare experience

Job Details:

Company: Mediclinic

Vacancy Type:  Full Time

Job Location: Stellenbosch, Western Cape, South Africa

Application Deadline: N/A

Apply Here

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