Claims Clerk Mozambique

Momentum Group Limited

About The Position

Through our client-facing brands Momentum Group, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members.

Requirements

Grade 12 or relevant qualification
1–2 years' claims processing experience
Knowledge of claims assessment, regulations and product rules
Strong analytical, communication and problem-solving skills
High attention to detail and customer focus

Nice To Haves

Analytical Thinking
Decision Making
Communication
Customer Focus
Attention to Detail
Problem Solving
Planning and Organisation
Teamwork
Time Management
Conflict Resolution

Responsibilities

Assist directly the Claims Team Leader and Ops Manager if necessary.
Processing claims submitted by health service providers for less than 10 days that include.
Assessment of claims as per the rules and protocols.
Close batch reconciliation.
Achieve expected daily/weekly productivity.
Report irregular cases on claims assessment.
Reprocessing and monitor claims of reconciliation process.
Monitor electronic submission of all health service providers through e-mail and system.
Processing South African claims.
Processing In-hospital claims.
Manage Claims express line.
Claims quality review of 5% of processing; Provide feedback to the internal audit if required.
Report system errors to claims supervisor and interact with back office if necessary.
Report all suspected fraud cases to Claims Supervisor and Ops Manager
Support Claims team leader on monthly reporting, until the 3rd day of the month.
Claims monthly report