medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in Port Elizabeth hospital nursing experience. Previous exposure to clinical auditing is highly advantageous. Be available Responsibilities Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization)
medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in Port Elizabeth hospital nursing experience. Previous exposure to clinical auditing is highly advantageous. Be available Responsibilities Internal Process: Apply scheme rules, clinical policies and protocols to funding. Action allocated case managers for resolution. Act as clinical support to non-clinical hospital claim auditors in terms of of hospital tariff applications and clinical guidance (e.g. procedures, devices and drug utilization)
Operations: Collation of all clients related information (data discovery and fact find) and preparation of documentation intermediary appointment notes to relevant PPs. Monitoring the submission of intermediary appointment notes with supporting documentation to relevant PPs. Monitoring the underwriting and acceptance of new business Schedules are up to date and accurate. Data capture of client demographic data on client relationship management system XPlan. Client financial data capture (ASTUTE, PPs and manual). Data integration between XPlan and
disciplinary code and procedures. Supervise and monitor agents within your team. Motivate and inspire team talk times, volume of calls, all stats, gaps. Monitor revenue – lower sold plans to be investigated.
disciplinary code and procedures. Supervise and monitor agents within your team. Motivate and inspire team talk times, volume of calls, all stats, gaps. Monitor revenue – lower sold plans to be investigated.
skills, along with the ability to translate financial data into executable insights. Excellent communication functions and operations, as well as the supply of data for informed decision-making. Business savvy and
skills, along with the ability to translate financial data into executable insights. Excellent communication functions and operations, as well as the supply of data for informed decision-making. Business savvy and
office refreshments for all offices in the Company. Monitor the central e-mail accounts. Receive, validate the employee database on the commission system. Monitor and reconcile the daily bank statement relating
office refreshments for all offices in the Company. Monitor the central e-mail accounts. Receive, validate the employee database on the commission system. Monitor and reconcile the daily bank statement relating
Audit assignment budget planning and management. Monitoring and evaluation of performance in relation to