213 Application support specialist Jobs and Work in Johannesburg, Gp

Claims Support Specialist
Oneplan Underwriting Managers (Pty) Ltd. —Sandton, Gauteng
- Full-time
ICG – Senior South Africa Coverage Sales – Director
Deutsche Bank —Johannesburg, Gauteng
- Full-time
1h
Senior Quotation and Order Management Specialist
Metso —Alberton, Gauteng
6h
Systems Engineer
Expleo —Johannesburg, Gauteng 2000
8h
Sales Development Representative (Outbound Emails)
Trialfacts —Johannesburg, Gauteng
- Full-time
- Remote
Quick Apply
8h
Technology Technical Representative x2 Global Grade 10
Barloworld Equipment —Isando, Gauteng
- Full-time
Quick Apply
14h
Systems Engineer II
Ovations Technologies —Johannesburg, Gauteng
Quick Apply
15h
COE Specialist
Ovations Technologies —Johannesburg, Gauteng
Quick Apply
15h
Solution Architect
Nedbank —Johannesburg, Gauteng
16h
IDM Data Engineer
Nedbank —Johannesburg, Gauteng
16h
SCM Strategy & Performance Management Specialist : DP & E: FINA19237
City of Ekurhuleni —Ekurhuleni, Gauteng
- R494 016 - R677 664 a year
18h
Procurement Specialist
South Point Management Services —Johannesburg, Gauteng
- Temporary
Quick Apply
19h
Front Line Manager - BCM - Core Ops 4B
Genpact South Africa (Pty) Ltd —Johannesburg, Gauteng 2191
Quick Apply
19h
Ocean Freight Export Controller
DHL —Johannesburg, Gauteng
23h
Specialist: Quality Assurance
DHL —Boksburg, Gauteng
23h
Technical Specialist
FirstRand —Johannesburg, Gauteng
- Full-time
1d
German Speaking Customer Support Representative in Umhlanga!
Ignite —Johannesburg, Gauteng
Quick Apply
1d
Product Specialist - Lubricants
BMG - Bearing Man Group —Johannesburg, Gauteng
Quick Apply
1d
Marketing Intelligence Associate
BAAC ACCOUNTANTS AND BUSINESS ADVISORS —Rivonia, Gauteng 2128
- Full-time
Quick Apply
1d
Group Account Director
Publicis Groupe Holdings B.V —Johannesburg, Gauteng 2194
Quick Apply
1d

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Claims Support Specialist

Oneplan Underwriting Managers (Pty) Ltd.
Sandton, Gauteng

Apply Now

Job Details

Full-time

Full Job Description

Main purpose of the Job

To ensure that all Gap claims are accurately captured into the iMed system.

Position Specific Outputs

Duplicate check claims received, and process claims and emails according to processes.
Capture all claims received in accordance with relevant legislation and processes.
Review and process case and non - case related claims in accordance with coding principles, scheme rules and benefits, and managed care policies and processes
Providing coding review and resolution on call centre queries
Assess claims edit requests and actioning it in accordance with coding principles, scheme rules and benefits, and managed care policies and processes
Communicate with Stake holders
Maintain clinical documents and processes
Review and action QA reports and provide corrective actioning
Assist with training and sharing of knowledge within the team and clients
Assist on the various Call centres
Assist with call centre call backs.
Review and assess gap claims.
Verify documentation and ensure all required information is completed.
Communicate with clients and stakeholders to gather necessary information.
Process claims efficiently and accurately.
Maintain detailed records of claims and assessments.
Collaborate with other departments.
Assist with departmental Adhoc duties where required.

Operating Model:

Conduct accurate and effective intervention/reconciliation of administration on all allocated claims.
Accurately and efficiently process allocated claims according to the defined process and within Service Level Agreement.
Continuously apply relevant rules.
Follow documented Assessing policies and procedures pertaining to manual intervention and reconciliation of claims.
Rectify incorrect information on claims and escalate where required.
Reconcile claims where required and communicate outcome.
Ensure correct payments to vendor or member.
Meet delivery objectives through working with other team members within and linked to the department / project.
Resolve operational performance variations and problems and escalate unresolved issues to higher levels.
Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery.

Operational Implementation of Strategy:

Keep up to date with operational changes implemented in response to important external influences
Deliver in a manner that supports and meets operational quality standards and meets the defined departmental priorities
Perform according to defined operational best practice and identify and implement opportunities for continuous delivery improvement

Operational Leadership:

Deliver personal performance within Human Capital frameworks and policies to ensure delivery to agreed standards and objectives
Engage in development, coaching and mentoring
Support transformation through valuing diversity
Behave in alignment with the Afrocentric values

Stakeholder Management:

Investigate (through contacting relevant internal parties, providers or members), respond to and resolve valid claims and assessing queries or anomalies.
Identify, investigate, respond to and refer IT assessing queries appropriately.
Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achieved.
Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-in.

Minimum Academic, Professional Qualifications & Experience required for this position

Grade 12 with English and a second language
RE5(Advantageous)
3 years relevent healthcare industry, short term insurance and credit data capturing and claims processing experience.
1 Year Gap cover experience.

Competency Requirements

Knowledge:

Knowledge and application of relevant legislation
Knowledge and application of processes and procedures
Knowledge of scheme rules and contractual negotiations

Skill:

Problem solving and decision making skills
Business Writing Skills
Communication Skills
Computer Technology Skills
Task Management
Adobe Creative Suite
Data modelling and evaluation
Attention to Accuracy and Detail
Numerical Ability
Customer Focus
Multitasking
Strong analytical and problem solving skills
Proficiency in Microsoft Office Suite
Relevant systems knowledge and application

Apply Now

Refine Your Search

application support specialist jobs in johannesburg, gp

Claims Support Specialist

ICG – Senior South Africa Coverage Sales – Director

Senior Quotation and Order Management Specialist

Systems Engineer

Sales Development Representative (Outbound Emails)

Technology Technical Representative x2 Global Grade 10

Systems Engineer II

COE Specialist

Solution Architect

IDM Data Engineer

SCM Strategy & Performance Management Specialist : DP & E: FINA19237

Procurement Specialist

Front Line Manager - BCM - Core Ops 4B

Ocean Freight Export Controller

Specialist: Quality Assurance

Technical Specialist

German Speaking Customer Support Representative in Umhlanga!

Product Specialist - Lubricants

Marketing Intelligence Associate

Group Account Director

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