Claims Administrator urgently needed: APPLY NOW
We believe in nurturing talent and providing a platform for growth. As we expand our horizons, we are building a talent pool of passionate Claims Administrators who share our commitment to excellence.
Job Summary
Administer payments of Health claims
Key Responsible Areas
Process hospital admission and related accounts received
Perform administrative duties
Tasks
Process hospital admission and related accounts received
Receive accounts and authorisation letters
Opening accounts received
Compare ICD10 codes to determine if it’s a condition we cover or an exclusion
Process day to day claims
Perform administrative duties
Capture notes into the relevant folders and claims management system
Advise the Providers/ Members when maximum benefits have been paid
Request decline letters for conditions/ accounts not covered
Engage with Members/ Providers regarding their queries
Contact Members when they are unsure about their cover, benefit limits, declines or payment allocations and provide them with detailed statements or reports
Provide Members, Agents or Service Providers with feedback with regards to the claim progress
Check hospital claims for correctness (completed in full)
Send proof of payments to Members/ Service providers
File POP’s and accounts
Send out daily statistics
Obtain all the relevant documentation required for the applicable benefit
Perform administrative duties:
File all relevant emails
Capture claims on the claims management system
Reconcile account received and send to the financial administrator for payments to be loaded
Compile and submit periodic reports
Essential Qualifications
Matric
Essential Experience
Minimum 2 years in the insurance industry and its products.
Knowledge and Skills:
Excellent administrative skills
Knowledge of medical claims handling
Knowledge of and adherence to the Policies and Procedures relating to hospital claims
Knowledge of medical operating systems
Excellent computer skills (MS Office, Excel)
Excellent written and communication skills
Time management skills
Excellent interpersonal skills
Client relationship-building skills
Attributes
Patience (to deal with difficult Members)
Positive attitude
Ability to multi-task
Professional demeanor and appearance
Team player/ work independently
High level of enthusiasm
Innovative/ energetic
Ability to work under pressure
High degree of commitment
Motivated
Accuracy
Deadline orientated
Honest, hardworking, and humble. Apply Now
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