Quality Assessor

Welcome to the Latest Job Vacancies Site 2025 and at this time we would like to inform you of the Latest Job Vacancies from the Momentum Health with the position of Quality Assessor - Momentum Health which was opened this.

If this job matches your qualifications, please send your application directly through our latest Job site. Indeed, every job is not easy to apply because it must meet several qualifications and requirements that we must meet in accordance with the standard criteria of the Company who are looking for potential candidates to work. Good job information Quality Assessor - Momentum Health below matches your qualifications. Good Luck: D

Introduction Through our client-facing brands Metropolitan and Momentum, with Multiply (wellness and rewards programme), and our other specialist brands, including Guardrisk and Eris Property Group, the group enables business and people from all walks of life to achieve their financial goals and life aspirations. We help people grow their savings, protect what matters to them and invest for the future. We help companies and organisations care for and reward their employees and members. Through our own network of advisers or via independent brokers and utilising new platforms Momentum Metropolitan provides practical financial solutions for people, communities, and businesses. Disclaimer As an applicant, please verify the legitimacy of this job advert on our company career page. Role Purpose This role offers exciting and challenging opportunities for a dynamic, performance-oriented, knowledgeable, and experienced individual. The candidate must deliver quality outputs in a fast-paced, high-volume client-oriented environment, excelling both independently and as part of a team. This position is essential for maintaining and improving the quality standards across the organisation, ensuring exceptional client service and operational efficiency. Requirements Qualifications

• Valid Matric Certificate

Knowledge

• Knowledge of Claims operating systems
• Multi discipline claims knowledge
• Ability to interpret and apply scheme rules correctly
• Knowledge of the NHRPL- National Health Reference Price List and SAMA- South African Medical Association tariffs
• Good knowledge of PMB at industry level as well as in house PMB- Prescribed Minimum Benefits processes
• Good knowledge of tariff codes, rules(Scheme and Industry), modifiers and their application
• Ability to quality assess (QA) claims holistically, and possible fraudulent trends of providers
• Identify various types of anomalies, which include high risk transactions, engage with BI to develop a criteria to extract the correct information for a report

Experience

• 3-5 years Claims assessing experience, preferably in a Medical Aid industry
• Computer literacy (Email, Word and Excel)

Duties & Responsibilities INTERNAL PROCESS

• Establish, maintain and monitor a complete quality assurance claims system and ensures standards are met
• Identify system error and report it to relevant stakeholders and ensure its rectified
• To Identify initiatives that will add value to the company/department
• Ensure your daily and monthly targets are met
• To work according to the Claims Framework
• To work on ad hoc task if and when it is required
• Identifying training interventions to address individual needs
• Quality checking random sample of claims and claims enquiries
• Assist with staff development by identifying trend analysis and training needs through QA
• Work with coaches and service managers and advise them of progress of staff
• Maintaining the confidentiality of sensitive information
• To facilitate and maintain open communication with other departments or stakeholders
• Provide regular reports on delivery of services against agreed service level agreements and in terms of overall customer targets
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service
• Develop and maintain productive and collaborative working relationships with peers and stakeholders
• Positively influence and participate in change initiatives; continuously develop own expertise in terms of professional, industry and legislation knowledge
• Contribute to continuous innovation through the development, sharing and implementation of new ideas
• Take ownership for driving career development
• Identify opportunities to enhance cost effectiveness and increase operational efficiency

CLIENT

• Build and maintain relationships with designated stakeholder groups (including clients & internal stakeholders)
• Deliver on service level agreements applicable to clients and internal and external stakeholders to ensure that client expectations are managed
• Make recommendations to improve client service and fair treatment of clients within the area of responsibility
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback, and provides exceptional client service
• Continuously monitor turnaround times and quality standards and resolve issues swiftly to enhance client service delivery
• Manage client query processes, ensuring queries are tracked, accurately resolved, and used as a mechanism to improve client service and business processes

PEOPLE

• Build strong relationships by providing specialist know-how and leadership to others, expressing positive expectations
• Continuously develop own expertise in industry and subject matter, applying it in specialisation
• Positively influence and manage change, offering specialist support where required
• Contribute to continuous innovation through the development, sharing, and implementation of new ideas and involvement of colleagues and staff
• Participate and contribute to a culture of work-centric thinking, productivity, service delivery, and quality management
• Take ownership of driving career development

FINANCE

• Contribute to the development of area-specific budgets to minimise expenditure, aligning with operational plans
• Identify solutions to enhance cost-effectiveness and increase operational efficiency
• Implement and provide input into governance processes and systems within the area of specialisation
• Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution
• Provide input into the risk identification processes development and communicate recommendations in the appropriate forum as to ensure QA framework alignment

Competencies

• Excellent communication, listening and interpersonal skills
• Ability to liaise professionally and courteously at all levels
• Ability to exercise discretion
• Pro-activeness and drive
• Good decision-making skills
• Assertiveness
• Ability to work independently
• Ability to work under pressure
• Ability to remain and act neutral / impartial
• Ability to communicate recommendations in a constructive manner
• Sound knowledge of scheme rules and benefits
• Be able to interpret payment instructions from relevant SPNs
• Be able to read claims raw data and access real-time claims

Information :

• Company : Momentum Health
• Position : Quality Assessor
• Location : Bellville, Western Cape
• Country : ZA

How to Submit an Application:

After reading and knowing the criteria and minimum requirements for qualifications that have been explained from the Quality Assessor job info - Momentum Health Bellville, Western Cape above, thus jobseekers who feel they have not met the requirements including education, age, etc. and really feel interested in the latest job vacancies Quality Assessor job info - Momentum Health Bellville, Western Cape in 2025-04-14 above, should as soon as possible complete and compile a job application file such as a job application letter, CV or curriculum vitae, FC diploma and transcripts and other supplements as described above, in order to register and take part in the admission selection for new employees in the company referred to, sent via the Next Page link below.