Shoprite Group Healthcare / Medical / Nursing Jobs in Gauteng
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Purpose of the Job
Overseeing all employees in the Receiving Claims department to make sure daily goals are met. Activities related to claim processing and follow-up are under supervision and in accordance with relevant policies and procedures.
Job Category: Pharmaceutical
Job Objectives
- Direct supervision of the day-to-day activities in the department to ensure that claims are resolved within the required service level agreement.
- Maintaining and recording claim information, including details about the situation that resulted in the claim, dates of service rendered, and other relevant information.
- Act as an intermediary between Transpharm and client and timeously relay communication, requests and documentation.
- Follow the recoveries process, and diaries follow-ups and keep all stakeholders informed.
- Continuously monitor and initiate claims improvement processes and policies.
- Ensure compliance to contracted service levels and optimised processes.
- Manage internal and external relationships.
- Manage loss costs and loss expenses.
- Frequently communicate with all appropriate parties involved with the claim.
- Regularly review system reports, and respond promptly if necessary to resolve queries in a reasonable timeframe and to escalate where necessary.
- Create and maintain reports for submission to management.
- Checking whether calculations are correct, duplicate invoices are not being passed.
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- Dealing with payment, debit note queries and ad hoc queries.
- Keep internal systems and records up to date at all times.
- Keep relevant internal stakeholders up to date on the progress of claims.
- Make an assessment of claims validity and estimate value and administer claims.
- Responsible for training employees; planning, assigning and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.
- Continually review and measure team activities against targets, standards and service levels, agreeing and taking actions to improve capability and performance so that the team achieves its maximum potential.
- Perform personnel administration when necessary.
- Ensure that staff comply with health and safety policies and procedures.
- Accountable for keeping the department organized, conducting investigations, and enforcing all warehouse systems, processes, and procedures
Qualifications
Essential
- Matric qualification
Experience
Essential
- 3 - 5 years of experience working in a warehouse environment in a similar role
- 2 - 3 years of experience working as a supervisor
Knowledge and Skills
- Highly effective supervisory skills and techniques.
- Strong numerical skills.
- Diligently attends to details and pursues quality in accomplishing tasks.
- Develops fresh ideas that provide solutions to all types of workplace challenges.
- Excellent communication and interpersonal skills.
- Strong organisational and time management skills.
- Hands-on commitment to getting the job done.
- Knowledge of warehouse systems such as Pos-i-Till and MS Office proficiency.
- Proven ability to direct and coordinate operations.
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