| Job Title: | Claims Administrator | ||
| Recruiter: | Clicks | REF: | 28264/CLCK/Claims Administrator X5/280917 |
| AA/EE: | Applicable | Contract | Temporary / Contract |
| Location: | Roodepoort | Available: | ASAP |
| Category: | Pharmaceutical / Medical / Healthcare / Hygiene | Offer: | Market Related |
Overview
We are looking to recruit Claims Administrators to work for Clicks Direct Medicines (CDM) in the Data Validation Department. The role will be based at Roodepoort, JHB and will report to the Pharmaceutical Quality Control Supervisor
Purpose and Objectives
To claim all prescriptions loaded by the pharmacist and resolve medical aid claim rejections, by establishing the reason for the rejections by corrective action
Requirements
- To resolve medical aid rejection queries with member where medical aid has no impact e.g. benefit exceeded
- To resolve medical aid rejection queries with medical scheme e.g. medication authorization
- To provide member with status update regarding rejection and resolution thereof.
- To resubmit all rejections within target set per medical aid i.e. between 40 and 60 queries per day to medical aid three days prior to due date of delivery
- To resolve queries received from patients within a two hour turn-around time e.g. extended supplies due to member going oversees
Skills, Abilities and Job Related Knowledge:
- Communication skills (3 months)
- Problem solving skills (3 months)
- IT applications areas and delivery channels (Marconi, Phoenix and Exsol)
- Current IT technology (6 months)
- Medical Aid Formularies (6 months)
- Product knowledge (1 year)
- Pharmacy Council Legislation (1 year)
Essential Competencies:
- Analysing
- Deciding and Initiating Action
- Adhering to Principles and Values
- Persuading and Influencing
- Working with People
- Adapting and Responding to Change
- Achieving Personal Work Goals and Objectives
- Applying Expertise and Technology
- Following Instructions and Procedures
- Delivering Results and Meeting Customer Expectations
