Primarily an Administration function, the role will be responsible for the following
- Effective coordination of the end-to-end policy claims process, i.e.
- Claims administration
- Claims assessment
- Claims authorisation
- Ownership of the policy claims process and associated SLAs
- Collation and evaluation/assessment of claims documentation
- Correspondence with clients regarding the progress and outcomes of claims assessment process
- Liaison/Correspondence with 3rd parties regarding access to information required to assess claims
- Liaison/Correspondence with authoritative and legal entities such as the Council for Medical Schemes, the Ombudsman, etc.
- Thorough evaluation, assessment and authorisation of claims
- Recording and communication of outcomes of claims
- Management and coordination of claims payment runs
- Assistance with other functions within Administration area if and when required
Generic key result areas
- Claim Processing and operational effectiveness
- Functions as a subject matter expert in a specific field of administration / product / process
- Resolves technical and complex problems in support of administrative queries/issues
- Personal effectiveness
- Accountable for client service delivery through own efforts
- Accountable for managing own time, tasks and output quality
- Makes increased contributions by broadening individual skills
- Accepts and lives the company values
- Effective team player with high level of interpersonal skills
- Quality Assurance
- Performs quality checks on own work
- Adheres to service and quality standards
Requirements for the role
- Knowledge and experience of claims processing
- Minimum 3 years’ experience in Medical Scheme/Health Insurance industry
- Very strong client service focus
- Attention to detail
- Strong analytical skills
- Relationship management skills
- Strong administration skills
- Operational efficiency
Desired Work Experience
Desired Educational Level