Job Summary
Core Purpose
At Medihelp, we live our values daily — excellence, compassion, collaboration, and transparency — to make a real difference in the lives of our members. We’re looking for someone who lives these values through their mindset, work ethic, and interactions with others.
The Senior Clinical Claims Reviewer primarily audits hospital, private nursing, and wound care claims using knowledge of hospital contracts and negotiated tariff structures.
REQUIREMENTS
Grade 12 and an Enrolled Nurse or Nursing Assistant qualification
Current registration with the SANC
At least two years’ experience in clinical account review and auditing, preferably in a hospital or managed care environment
Comprehensive knowledge of the Medical Scheme Act, with sound knowledge of ICD-10, CPT-4 & RPL codes
Knowledge of the Scheme Rules, Scheme Tariffs and exclusions
KEY COMPETENCIES
Excellent written and verbal communication skills
Proficiency in Microsoft Office
Customer-focused approach
Strong negotiation skills
Ability to work independently and collaboratively
Ability to build positive working relationships• Sound decision-making skills
Join a team where our values guide everything we do — from how we work together to how we serve our members.
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