Careers 

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

• 3 to 5 years

Desired Educational Level

• Grade 12 / Matric