27 Medical Claims jobs in South Africa

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Are you eager to grow and join a highly specialised team in the area of medical debt management? Become part of an exciting service based solution driven on the back of cutting edge healthtech, artificial intelligence and debt management processes.

As a Medical Claims Administrator , you will be required to deliver an efficient , consistent and accurate administrative medical debt service to clients. You will also provide the Doctors with monitoring and bureau reports that will allow them to have real time data on the financial status of their practice. You will become a trusted business partner ensuring that their cash flow is timeous and that aged debt is at a minimum.

Key Responsibilities:

• Capture patient demographics and claims accurately.
• Ensure that all claims are accurate before they are submitted to the Medical Schemes
• Clear claim rejections as soon as notified.
• Reconcile and monitor all remittances.
• Follow-up on all outstanding claims.
• Maintain a low age analysis.
• Follow up on short payments.
• Follow up on claims regularly with valid updates at each point of query.
• Keep constant communication open with the practice and the client.
• Build and maintain relationships with clients.
• Monitor and maintain doctors' databases.

Qualifications and Experience

• Matric
• A relevant administrative qualification is advantageous
• 2 to 3 years industry experience is essential
• Must have knowledge on PMBs

Knowledge and Skills

• Must have knowledge on PMBs
• High level of computer literacy
• High level of numeracy
• Google Workspace experience is advantageous

The salary bracket for the role is around R15k CTC p/m. Note that it is the client's prerogative, regardless of advertised package, to offer a market related salary considering the candidate's qualifications, skills, and level of experience.

• Seniority level Associate

• Employment type Full-time

• Job function Health Care Provider and Administrative
• Industries Medical Practices and Hospitals and Health Care

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Medical Claims AdministratorReference : PTA-CB-2We are looking for a Medical Claims Administrator for a big, amazing and innovative company in the health tech space.Duties & ResponsibilitiesThe purpose of the team that you will become part of is to launch a service-based solution driven by cutting-edge health tech, artificial intelligence, and debt management processes (primarily focused on the private medical specialists market).

You will focus strongly on client delivery and at the same time make a difference in the lives of doctors and patients alike.

You will deliver an efficient, consistent, and accurate administrative medical debt service, providing the doctors with monitoring and bureau reports that will allow them to have real-time data on the financial status of the practice.

You will become their trusted business partner, ensuring that their cash flow is timely and that their aged debt is at a minimum.Duties : Ensure that all claims are accurate before they are submitted to the medical schemes.Clear claim rejections as soon as you are notified.Reconcile and monitor all remittance advices.Select correct scheme agreements so that the client is able to post the correct rates annually.Follow up on all outstanding claims.Re-submit outstanding claims that need fixing.Maintain a low age analysis if not zero.Follow up on short payments.Follow up on claims regularly with valid updates at each point of query.Keep constant communication open with the practice and the client.Build and maintain relationships with clients.Monitor and maintain doctors databases with the assistance of BI reporting.Qualifications and Skills : Matric and relevant administrative qualification.G-Suite experience is advantageous.2-3 years industry knowledge.Must have knowledge on PMB's.Customer service oriented.Initiative and commitment to achieve.Attention to detail and quality.Teamwork oriented.Excellent communication skills.Diplomacy.Presentation skills.Adaptability.Analytical thinking.Continuous learning.Package & RemunerationR - R - MonthlyNOTE : We ONLY accept online applications.

We do not consider direct applications via WhatsApp or email.

SALARY DISCLAIMER : The advertised salary range is merely a guideline to attract a range of potentially suitable candidates to the advertised position.

This doesn't automatically mean that a successful candidate can claim an offer for the maximum advertised salary.

It is the prerogative of the future employer to offer a candidate a market-related remuneration package in line with the candidate's qualifications, skills, and level of experience.

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Medical Administrator • Durban, KwaZulu-Natal

Our client operating in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in Port Elizabeth - on a 6 month fixed term contract.
Nursing Diploma or Degree essential!
EE candidate preference.
An awesome career opportunity awaits!

Role Purpose
The purpose of this temporary role is to ensure hospital claims are audited timeously and accurately with the focus on reducing wastage and abuse, as well as to ensure that claims are processed according to authorizations for a period of 6 months only.

Requirements

• A National Senior Certificate is essential.
• It is essential to have a Nursing Diploma or Degree.
• The incumbent must be registered with the South African Nursing Council (SANC) as a Registered Nurse.
• MS Office / Office 365 proficiency.
• Minimum of 2 years’ private hospital nursing experience.
• Previous exposure to clinical auditing is highly advantageous.
• Be available to work at one of our offices based in Richmond Hill (Gqeberha), Cornubia (Durban), Bellville (Cape Town) or Centurion.

Responsibilities

INTERNAL PROCESS

• Apply scheme rules, clinical policies and protocols to funding.
• Action allocated hospital claims for audit within department KPIs and CMS requirements for claims payment.
• Ensure accurate notes are made for all journals actioned on claims audited.
• Assess prosthesis for PMB funding when benefits are exceeded or if there is no benefit.
• Ensure accurate completion of authorizations on claim finalization.
• Refer LOC/ LOS / item or drug approval queries to case managers for resolution.
• Act as clinical support to non-clinical hospital claim auditors in terms of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization).
• Survey claims for correct application of tariff and refer discrepancies to the relevant team.
• Review retrospective claim approvals and send journal instructions for additional payments to the relevant team.
• Review hospital claims for clinical appropriateness, treatment authorized, over-usage of equipment/materials, application of billing rules and high-cost medication appropriateness.

CUSTOMER SERVICE

• Investigate hospital claim queries within the agreed service level and ensure that the relevant stakeholder receives timeous feedback.
• Escalate queries to the relevant team or stakeholder.
• Provide accurate information and advice to stakeholders to ensure that they receive the appropriate service.
• Resolve claim queries accurately and timeously.
• Build and maintain relationships with internal and external stakeholders.
• Reduce claim rejections to ensure members are not held liable for unnecessary costs.

PEOPLE

• Build strong relationships through expressing positive expectations.
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialization.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
• Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.

FINANCE

• Identify opportunities to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

Competencies

• Teamwork
• Examining information (interrogate claims data)
• Articulating information
• Upholding standards
• Accountability
• Attention to detail
• Time management

Please consider your application unsuccessful if you are not contacted within two weeks of applying.

Monthly

Our client operating in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in Port Elizabeth - on a 6 month fixed term contract.
Nursing Diploma or Degree essential!
EE candidate preference.
An awesome career opportunity awaits!

Role Purpose
The purpose of this temporary role is to ensure hospital claims are audited timeously and accurately with the focus on reducing wastage and abuse, as well as to ensure that claims are processed according to authorizations for a period of 6 months only.

• A National Senior Certificate is essential.
• It is essential to have a Nursing Diploma or Degree.
• The incumbent must be registered with the South African Nursing Council (SANC) as a Registered Nurse.
• MS Office / Office 365 proficiency.
• Minimum of 2 years’ private hospital nursing experience.
• Previous exposure to clinical auditing is highly advantageous.
• Be available to work at one of our offices based in Richmond Hill (Gqeberha), Cornubia (Durban), Bellville (Cape Town) or Centurion.

• Apply scheme rules, clinical policies and protocols to funding.
• Action allocated hospital claims for audit within department KPIs and CMS requirements for claims payment.
• Ensure accurate notes are made for all journals actioned on claims audited.
• Assess prosthesis for PMB funding when benefits are exceeded or if there is no benefit.
• Ensure accurate completion of authorizations on claim finalization.
• Refer LOC/ LOS / item or drug approval queries to case managers for resolution.
• Act as clinical support to non-clinical hospital claim auditors in terms of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization).
• Survey claims for correct application of tariff and refer discrepancies to the relevant team.
• Review retrospective claim approvals and send journal instructions for additional payments to the relevant team.
• Review hospital claims for clinical appropriateness, treatment authorized, over-usage of equipment/materials, application of billing rules and high-cost medication appropriateness.

• Investigate hospital claim queries within the agreed service level and ensure that the relevant stakeholder receives timeous feedback.
• Escalate queries to the relevant team or stakeholder.
• Provide accurate information and advice to stakeholders to ensure that they receive the appropriate service.
• Resolve claim queries accurately and timeously.
• Build and maintain relationships with internal and external stakeholders.
• Reduce claim rejections to ensure members are not held liable for unnecessary costs.

• Build strong relationships through expressing positive expectations.
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialization.
• Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
• Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.

• Identify opportunities to enhance cost effectiveness and increase operational efficiency.
• Manage financial and other company resources under your control with due respect.
• Provide input into the risk identification processes and communicate recommendations in the appropriate forum.

• Teamwork
• Examining information (interrogate claims data)
• Articulating information
• Upholding standards
• Accountability
• Attention to detail
• Time management

Please consider your application unsuccessful if you are not contacted within two weeks of applying.

Monthly

• Prepare accurate cost estimates, budgets, and tender documentation
• Manage project finances, including valuations, variations, and final accounts
• Liaise with clients, contractors, and suppliers
• Monitor project progress and control costs to ensure profitability
• Provide regular financial reports and risk assessments
• Ensure compliance with relevant building regulations and contract terms

• BSc or NDip in Quantity Surveying or related field
• Minimum 35 years experience in the building industry
• Solid understanding of commercial, residential, and public sector construction
• Strong analytical and negotiation skills
• Proficient in cost management software and MS Office
• Excellent communication and reporting abilities
• Valid drivers licence and own transport preferred

Pacific International Insurance is a licensed general insurance provider, offering reliable coverage for policyholders across Australia and New Zealand. Our diverse range of personal and business insurance solutions includes motor vehicle, pet, mobility equipment, professional indemnity, and general liability insurance.

PD Insurance AU offers award-winning, affordable, and high-value pet and car insurance coverage.

Are you a customer-focused, energetic, and passionate individual? We are on the hunt for a Claims Consultant to join our vibrant call centre team in George. This is your chance to make a real impact and be part of a dynamic team!

Ensuring that claims are processed in an accurate and timely manner, mitigating claims costs in accordance with policy guidelines, delegated authorities’ industry laws and regulations.

As a customer facing role, this position embraces our Soft Landings philosophy in ensuring a high level of customer service from lodgment to claim closure.

In exchange, we will provide you with a fun and collaborative team environment, a supportive management system, and the motivation to reach your full potential!

• Competitive basic monthly salary with company benefits and contributions.
• Employee loyalty and long service rewards.
• Professional company branded gear.
• Health benefits: exciting offers from our Lifestyle department to keep you fit and healthy!
• On-site coffee shop and restaurant dedicated to our employees.
• Training and development: all newbies undergo a training programme to equip you with the knowledge and tools to thrive in your role.
• Working hours that provide you with more flexibility during the day.
• Company transport available to the office.

• Mondays to Fridays: 03h30 – 11h00 AM OR 00h00 – 07h30 AM (2 rotational shifts)

These working hours accommodate our clients and colleagues in Australia and New Zealand. Providing you with more flexibility during your day!

About the Company:

Pacific International Insurance is a licensed general insurance provider, offering reliable coverage for policyholders across Australia and New Zealand. Our diverse range of personal and business insurance solutions includes motor vehicle, pet, mobility equipment, professional indemnity, and general liability insurance.

About the Product:

PD Insurance AU offers award-winning, affordable, and high-value pet and car insurance coverage.

The Opportunity:

Are you a customer-focused, energetic, and passionate individual? We are on the hunt for a Claims Consultant to join our vibrant call centre team in George. This is your chance to make a real impact and be part of a dynamic team!

What’s the overall purpose of this position?

In exchange, we will provide you with a fun and collaborative team environment, a supportive management system and the motivation to reach your full potential! ?

Some of the benefits:

• Competitive basic monthly salary with company benefits and contributions.
• Employee loyalty and long service rewards.
• Professional company branded gear.
• Health benefits: exciting offers from our Lifestyle department to keep you fit and healthy!
• On-site coffee shop and restaurant dedicated to our employees.
• Training and development: all newbies undergo a training programme to equip you with the knowledge and tools to thrive in your role.
• Working hours that provide you with more flexibility during the day.
• Company transport available to the office.

Working hours:

• Mondays to Fridays: 03h30 – 11h00 AM OR 00h00 – 07h30 AM (2 rotational shifts)

These working hours accommodates our clients and colleagues in Australia and New Zealand. Providing you with more flexibility during your day!




We would love to receive your application if you meet the following requirements:

• Completed Grade 12 / National Senior Certificate.
• Excellent written and verbal communication skills in English. You will need a clear English accent and be able to understand the whacky Aussie and New Zealand accents!
• Intermediate level computer skills.
• Prior experience in a customer service orientated position.
• Strong attention to detail, organisational and administration skills.
• Willing to work “night-shift” hours (to accommodate the Australian and New Zealand operating hours of clients and colleagues).
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Other skills that would be advantageous:

• Previous experience handling insurance claims or working in a financial services institution.
• Skills in negotiation, persuasion and investigation with customers and service providers.
• Sound interpersonal skills, building rapport with customers and service providers.
• Skilled in asking probing questions and gaining detailed information to support claims handling.

• Make and receive calls to clients
• Gather and follow up all info and documents required to register claims
• Advise on claims under what section covered on policies
• Interact and follow up with Insurers
• Involvement with claims intermediary service (Client satisfaction)
• Follow claims through to Agreement of Loss and signed by client
• Use logic and intellect to ensure customers are treated fairly
• Build trust-based relationships with clients

Key Skills and Competencies:

• Good verbal and written communication skills at all levels
• Computer literate in Microsoft Office and internet
• Self-discipline and time management
• Punctuality

Candidates must have the following qualifications:

• Grade 12

Competence:

• Experience (1+ Years in industry)
• Class of Business completed for STI Personal and Commercial lines
• Operational Ability
• Product Specific Training

The following additional factors will be to your (Candidates) advantage:

• Experience on SANTAM online system
• Product specific training completed with main players in insurance industry: Santam, Old Mutual, Momentum (Previously Alexander Forbes), Bryte et

Main characteristics / strong points for candidates:

• Good verbal- and written communication skills at all levels
• Computer literate in Microsoft office and internet
• Self-discipline and time management
• Punctuality
• Make and receive calls to clients
• Gathering and follow up all info and documents required to register claim.
• Advise on claims under what section covered on policies.
• Interaction and follow up with Insurers
• Involvement with claims intermediary service (Client satisfied).
• Follow claim through to Agreement of Loss and signed by client.
• Logic and intellect to ensure customers treated fairly.
• Build relationships (Trust) with clients