Medical Claims Validator

Together with our client, a leading claims administrator in Pretoria East, we are recruiting for a Medical Claims Validator to join their team. The ideal candidate needs to have minimum 2 years Medical claims related experience and must have matric/grade 12. Duties and Responsibilities: Operational: Assess COID claim information Assess billing on account per item in terms of COID Gazette Assess accounts against payment history received from COID Practice management of assigned practices Effective communication with assigned practices Assisting with client support and operational queries on accounts submitted; Provide medical advice and/or direction on claims to clients; Following up on outstanding information required from clients and employers for processing of medical claims and invoices; Resolve enquiries from clients related to the COID Act and medical treatment of patients; Contribute to daily operations; and Endure that all procedures are followed and that all production goals are met. Adhere to production deadlines. Assist to accomplish set revenue targets. Assist with training of newly appointed staff in the same division. Updating DS system with the relevant claim numbers from the Compensation Fund system. Upload of medical reports in the prescribed format on the Compensation Fund system. Assist in other areas of the department where required Ad-hoc: As a team member add value and contribute to the company; Assist to accomplish set revenue targets; Show willingness to adapt to industry and company changes; Show positive attitude towards your job, colleagues and clients; Be willing to share knowledge, do training and comply with set company policies; and Assist in other areas of the department where required Minimum Qualifications and Education Requirements: Matric / Grade 12; Tertiary qualification will be beneficial; Experience in Client and Funder Communication essential; and Medical claims related experience will be essential . Preferred Skills, Competencies & Personal Traits: Computer literate in MS Office (Microsoft Excel, Word, and Outlook) Articulate with strong communication skills (oral and written); CompEasy / Exempt funders / Medical claims online systems will be beneficial; Exhibits an inquisitive nature and a proactive, problem-solving attitude; Ability to adapt and learn new skills; Ability to multitask; and Cope well under pressure . Remuneration Market related - depending on experience Only candidates who meet all the requirements stipulated in this advert will be considered. If you don’t receive feedback from us within 2 weeks of your application, please consider your application unsuccessful.

Location: Pretoria, ZA

Posted Date: 11/9/2025