Query Resolution Officer at Momentum Group – Apply Now!

💼 Role Purpose:

Momentum Group, a leading provider of wellness and financial solutions, is seeking a Query Resolution Officer to join our Momentum Health team in Cape Town. This is an exciting opportunity to take ownership of escalated client queries, providing resolutions with accuracy and professionalism. You’ll be instrumental in maintaining high standards of customer service while resolving complex medical aid claims. If you have a passion for problem-solving and client care, this role is for you!

🧠 Key Responsibilities:

✔️ Claims Query Resolution: Efficiently resolve escalated claims queries to ensure timely and accurate processing.
✔️ Claims Reprocessing: Correctly reverse and reprocess claims when necessary, ensuring no duplicate claims are processed.
✔️ Pay Code Application: Ensure the correct pay codes are applied during the claims process.
✔️ Interdepartmental Collaboration: Liaise with other departments to resolve issues and assist in claim-related inquiries.
✔️ Customer Interaction: Maintain detailed records of all customer interactions in the workflow system, ensuring high-quality service and accountability.
✔️ Service Excellence: Strive to provide excellent customer service and adhere to high-quality standards.

📚 Qualifications & Experience:

✅ Matric / Grade 12 – Minimum requirement
✅ 3 – 4 years’ experience in claims assessing – Preferred
✅ Numeracy & Literacy Skills – Strong communication, math, and reading comprehension skills.
✅ Multidisciplinary Claims Knowledge – Preferably in medical aid claims (paper and/or EDI).
✅ PMB Knowledge – Familiarity with industry-level PMB processes and modifiers.
✅ Experience with SAMA Tariffs and NHRPL – Knowledge of National Health Reference Price List (formerly BHF).
✅ Computer Literacy – Competent in Microsoft Word, Excel, and email systems.

💪 Skills & Competencies:

🔹 Attention to Detail: Consistently ensures high levels of accuracy and precision in claim processing.
🔹 Problem-Solving Skills: Ability to resolve complex issues while maintaining service excellence.
🔹 Team Player: Works well within teams to achieve departmental and organizational goals.
🔹 Resilience Under Pressure: Ability to meet deadlines and handle difficult situations effectively.
🔹 Accountability: Takes responsibility for tasks and errors, and follows through with corrective action.
🔹 Client-Centered Approach: Focused on delivering exceptional service to internal and external stakeholders.

🏢 About Momentum Group:

Momentum Group is a leader in the financial services sector, providing innovative solutions to individuals and businesses. With renowned brands like Multiply and Guardrisk, we help clients achieve their financial goals, protect what matters, and invest in a prosperous future. Our commitment to excellence and service drives us to create positive experiences for both customers and employees alike.

🌐 Company Website: https://www.momentum.co.za

🔗 Find similar jobs at:
https://careerjunctionza.co.za/jobs/

📝 TIPS for a Strong CV for This Role:

📌 Highlight Your Claims Experience: Detail your hands-on work with medical claims, including processing, reprocessing, and resolving complex issues.
📌 Showcase Your Technical Skills: Emphasize your proficiency in Excel, Word, and other systems used in claims processing.
📌 Quantify Your Achievements: Mention how many queries you resolve or how you improved claims efficiency in previous roles.
📌 Customer-Centric Focus: Include examples of how you’ve successfully managed client expectations and provided high-quality customer service.
📌 Knowledge of Medical Aid Processes: Be sure to mention any experience or training related to PMB, modifiers, and tariffs (SAMA, NHRPL).
📌 Include Soft Skills: Demonstrate your problem-solving abilities, teamwork, and resilience, especially in high-pressure situations.