Medical Claims Specialist

Job Description

We are seeking a Medical Claims Specialist to join our dedicated team in Cape Town. The ideal candidate will be responsible for processing medical claims, verifying documentation, and ensuring compliance with regulations. Strong attention to detail and knowledge of medical coding is essential.

Responsibilities

• Review and assess medical claims for processing and payment.
• Communicate effectively with healthcare professionals and payers.
• Monitor claim submissions and follow up on outstanding issues.
• Implement best practices in claims processing.
• Keep up to date with regulatory changes affecting claims.
• Generate reports on claims status and trends.
• Serve as a point of contact for claims-related questions.
• Participate in continuous improvement initiatives.
• Document all communications regarding claims processing.
• Assist in resolving escalated claims issues with insurance companies.

Requirements

Education

• Diploma in Healthcare Administration or related field
• Bachelor's degree in relevant field is advantageous

Experience

• 3+ years of experience in medical billing or claims processing

Technical Skills

• Insurance Verification
• Healthcare Regulations Knowledge

Soft Skills

• Analytical Skills
• Interpersonal Skills

Certifications

• Healthcare Financial Management certification
• Certified Billing and Coding Specialist (CBCS)

Languages

• English: Fluent

Advantageous

• Previous experience in a fast-paced healthcare setting: Experience working in a dynamic environment handling high volumes.
• Advanced Excel skills: Experience using Excel for data analysis and reporting.

Benefits

• Attractive remuneration with annual bonuses
• Health and wellness benefits
• Retirement plan with company contributions
• Regular training and development opportunities

Company Culture

• Innovation: We strive for innovative solutions in all our operations.
• Respect: We maintain a respectful and inclusive environment for all employees.
• Work-Life Balance: We value work-life balance and support flexible working arrangements.