Clinical Claims Audit & Pre-Authorisation Assistant

🗏Job Type

Full Time

Qualified, registered nurse required for medical aid insurance company to handle pre-authorisations for members as well as claims auditing to identify fraud, utilisation trends and develop processes, presentations and reports.
* Pre-authorisation for members

* Analyse clinical data, utilisation statistics of members and healthcare providers

* Trends analysis

* Identify and investigate fraudulent claims

* Inter-departmental data sharing to ensure optimal patient care

* Develop processes to manage utilisation

* Develop reports, letters, presentations

* Liaise with clinicians, members, third party service providers

* Prefer at least 5 years' experience within medical aid/insurance industry in a similar role

* Nursing diploma/degree and registration with SANC

* Clinical Risk Management Certificate advantageous

* MS Office

* Knowledge of evidence-based medicine

R22 000 - R26 000 CTC (including medical insurance and Provident Fund)


Apply Here http://bit.ly/2wH7Gxl

Job id : , #71974, 31 views,

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