in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in and high-cost medication appropriateness. Customer Service: Investigate hospital claim queries within
in the medical insurance space is seeking a Medical Claims Clinical Auditor to join their team based in and high-cost medication appropriateness. Customer Service: Investigate hospital claim queries within
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.
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explanation of variances. Revenue/Debtors Check all medical aid claims are loaded on Health Bridge and correctly correctly submitted. Call Medical Aid in respect of submitted claims and confirm status of claims. Follow-ups
explanation of variances. Revenue/Debtors Check all medical aid claims are loaded on Health Bridge and correctly correctly submitted. Call Medical Aid in respect of submitted claims and confirm status of claims. Follow-ups
types of reports from medical practitioners Compare the reorts to our exisitng claims criteria to establish Insurance Assessing Medical Background Experience in both group and life individual life claims is essential
types of reports from medical practitioners Compare the reorts to our exisitng claims criteria to establish Insurance Assessing Medical Background Experience in both group and life individual life claims is essential