Services Consultant · Private Health Administration/Medical Aid Scheme (PHA) · November 2024 – April 2025
- Confirming member coverage based on medical plan and policy details
- Confirming consultation benefits for member and dependents
- Coding and pricing analysis; checking medical codes for accuracy and verifying associated costs against established fee scheduled
- Claim adjudication; handling claims rejection, explaining reason for denials and managing appeals processes, and claim reviews for copayment and shortfall
- Confirming monthly contributions to members and verifying debit order dates and correct amount to be debited
- Confirming if authorization is being approved or rejected
- Capturing notes and escalation of queries
- Reviewing and confirming of new application status
- Contact the billing department regarding payment allocation and billing dates schedule
- Answering and directing calls to their specific department