5. SSC/N2409 PC1. obtain required data/information for 100 10 5 5 (Coordinate health health insurance claims from appropriate insurance claims on sources behalf of healthcare PC2. validate the accuracy and 5 0 5 providers) completeness of data/information PC3. verify eligibility of claims against 10 5 5 policy documents PC4. analyze explanation of benefits (EoB) 15 5 10 documentation to determine amounts to be claimed PC5. enter claims onto billing systems, 15 5 10 following your organization’s procedures, guidelines and client-specific service level agreements (SLAs) PC6. complete claim forms in line with 15 5 10 health insurers’ requirements PC7. respond to queries from patients, 5 0 5 policyholders and health insurers in line with SLAs PC8. monitor payments from health insurers 5 0 5 and take action in case of delays in payment, in line with your organization’s procedures, guidelines and client specific service level agreements (SLAs) PC9. apply payments to relevant claims in 10 5 5 billing systems PC10. obtain advice and guidance from 5 0 5 appropriate people, where required PC11. comply with your organization’s 5 0 5 policies, procedures, guidelines and SLAs when coordinating health insurance claims Total 100 30 70 6.SSC/N9001 (Manage PC1. establish and agree your work 6.25 0 6.25 your work to meet requirements with appropriate people requirements) PC2. keep your immediate work area 12.5 6.25 6.25 clean and tidy PC3. utilize your time effectively 12.5 6.25 6.25 PC4. use resources correctly and 18.75 6.25 12.5 efficiently PC5. treat confidential information 6.25 0 6.25 correctly PC6. work in line with your 12.5 0 12.5 organization’s policies and procedures PC7. work within the limits of your job 6.25 0 6.25 role PC8. obtain guidance from appropriate 6.25 0 6.25 people, where necessary
5. SSC/N2409 (Coordinate health insurance claims on behalf of healthcare providers) PC1. obtain required data/information for health insurance claims from appropriate sources 100 10 5 5 PC2. validate the accuracy and completeness of data/information 5 0 5 PC3. verify eligibility of claims against policy documents 10 5 5 PC4. analyze explanation of benefits (EoB) documentation to determine amounts to be claimed 15 5 10 PC5. enter claims onto billing systems, following your organization’s procedures, guidelines and client-specific service level agreements (SLAs) 15 5 10 PC6. complete claim forms in line with health insurers’ requirements 15 5 10 PC7. respond to queries from patients, policyholders and health insurers in line with SLAs 5 0 5 PC8. monitor payments from health insurers and take action in case of delays in payment, in line with your organization’s procedures, guidelines and client specific service level agreements (SLAs) 5 0 5 PC9. apply payments to relevant claims in billing systems 10 5 5 PC10. obtain advice and guidance from appropriate people, where required 5 0 5 PC11. comply with your organization’s policies, procedures, guidelines and SLAs when coordinating health insurance claims 5 0 5 Total 100 30 70 6.SSC/N9001 (Manage your work to meet requirements) PC1. establish and agree your work requirements with appropriate people 6.25 0 6.25 PC2. keep your immediate work area clean and tidy 12.5 6.25 6.25 PC3. utilize your time effectively 12.5 6.25 6.25 PC4. use resources correctly and efficiently 18.75 6.25 12.5 PC5. treat confidential information correctly 6.25 0 6.25 PC6. work in line with your organization’s policies and procedures 12.5 0 12.5 PC7. work within the limits of your job role 6.25 0 6.25 PC8. obtain guidance from appropriate people, where necessary 6.25 0 6.25
NSQF_-_SIMPLIFIED_SSC_Q2401_V3.docx