Medical Claims Consultant - Cape Town - General Healthcare

Job Description

As a Medical Claims Consultant at Health Solutions Inc., you will be instrumental in the effective processing of medical claims. Your role will involve working closely with healthcare providers and patients to ensure efficient claims management. If you have a passion for healthcare and a keen eye for detail, this position is perfect for you. You will leverage your expertise to enhance our claims handling process, driving accuracy and compliance.

Responsibilities

• Handle inquiries related to medical claims from patients and providers.
• Verify patient insurance details and eligibility.
• Resolve denied claims through research and communication with relevant parties.
• Maintain organized records of all claims processed.
• Assist in audits of the claims process.
• Monitor claims for compliance with medical necessity criteria.
• Participate in team meetings to discuss ongoing claims management strategies.
• Prepare documentation and reports for management review.

Requirements

Education

• Bachelor's degree in Business or Health Sciences
• Advanced certifications in medical claims processing preferred

Experience

• 3+ years of experience in a related field

Technical Skills

• Claims Management Systems
• Billing Procedures

Soft Skills

• Problem Solving
• Teamwork

Certifications

• Certified Billing and Coding Specialist (CBCS)
• HIPAA Certification

Languages

• English: Fluent

Advantageous

• Experience in a healthcare setting: Previous experience working directly in a healthcare environment.
• Knowledge of the South African healthcare system: Understanding of the local healthcare policies and regulations.

Benefits

• Attractive salary with performance bonuses
• Additional training and certification opportunities
• Flexible work hours
• Team-building activities and social events

Company Culture

• Adaptability: We embrace change and are always looking for better ways to serve our clients.
• Growth-Oriented: We support personal and professional growth of our employees.
• Empowerment: We empower our employees by putting trust in their abilities.