Claims Assessor | Talent Pool

Discovery Health | Africa Health Hub

Medical Services Organisation | Claims Assessor

About Discovery

Discovery’s core purpose is to make people healthier and to enhance and protect their lives. We seek out and invest in exceptional individuals who understand and support our core purpose, and whose own values align with those of Discovery. Our fast-paced and dynamic environment enables smart, self-driven people to be their best. As global thought leaders, Discovery is passionate about innovating in order to not only achieve financial success, but to ignite positive and meaningful change within our society.

About The Discovery Africa Team

Discovery Africa is a subsidiary of Discovery Health and strategically extends Discovery’s reach through delivery in key business activities:

Provision of Health insurance products underpinned by Vitality and Shared value principles, targeting growth across the African continent. Products are currently sold in: DRC, Mozambique, Kenya, Zambia, Ghana, Nigeria and Tanzania.

Third Party Administration services provided to global, multi-national insurance organisations. Coverage extends to all countries on the African continent (except CAR and Guinea Bissau)

24/7 Medical assistance to inbound travellers to South Africa and outbound travellers to the rest of the world. This includes Discovery Health members covered under the international travel benefit (ITB).

By applying for this role, you are consenting to be placed in our Talent Pool for future recruitment, should we have met our recruitment numbers.

What is a Talent Pool?

In simplest terms, a talent pool is a database of candidates that have already been deemed qualified for particular positions and who can be offered roles as soon as they become available.

What does this mean for you?

It’s good news because it means, you will still go through the recruitment process (assessments, role plays and interviews) and if you meet our minimum criteria, will be next in line for consideration as soon as we require more staff.

You will remain as an active candidate on our database and we will update you on progress on a monthly basis.

Key Purpose:

The Claims Processor is responsible for processing Medical Service provider claims and functions within a team of claims team. He/ She works under the direct supervision of a Team Leader to ensure the achievement of client Service level objectives across the business unit.

Key Outputs:

Duties and responsibilities:

• Prepares payments and send remittances to providers 
• Captures and process claims as per the performance and productivity plan to achieve the client SLA. 
• Ensures correct and accurate tariff level capturing and processing according to member benefit. 
• Works closely with other team members to ensure alignment of activities to achieve client SLA objectives. 

• Participates in delegated projects. 
• Monitors own performance with due regard to quality audit feedback. 
• Provides detailed feedback within the prescribed SLA time frame to managers on exceptions and escalated matters. 
• Manages the validation process of claims received, as well as the mail-room paper process. 

Competencies:

The successful candidate must demonstrate the following competencies:

Education and Experience:

EMPLOYMENT EQUITY   
                             
The Company’s approved Employment Equity Plan and Targets will be considered as part of the recruitment process. As an Equal Opportunities employer, we actively encourage and welcome people with various disabilities to apply.